*Med-surge Ch 37 BISHOP (Nursing 3 exam 1)

What should be kept at the bedside of a patient immediately after thyroidectomy?

A. A ventilator B. An endotracheal tube C. An airway D. A tracheostomy tray D. A tracheostomy tray Laryngeal swelling is not uncommon in a patient after a thyroidectomy. A tracheostomy tray should be immediately available. A ventilator is not necessary, and the endotracheal tube will be very difficult, if not impossible, to intubate if edema has already occurred. An airway will be of no value, since the edema will be in the trachea.

A patient with acromegaly will most likely exhibit which symptom?

A. Bone pain B. Frequent infections C. Fatigue D. Weight loss A. Bone pain Acromegaly results from increased secretion of growth hormone, causing elongation and expansion of the bones. Infection and weight loss are not directly associated with this disorder. Although the disease process causes patients to become fatigued, the best answer is bone pain.

A patient with Addison's disease will most likely exhibit which symptom?

A. Bradycardia B. Hypotension C. Hirsutism D. Purple striae B. Hypotension Addison's disease is characterized by decreased function of the adrenal cortex, resulting in a deficit of all three hormones secreted by the adrenal cortex. The major problems are related to insufficiencies of the mineralocorticoids and the glucocorticoids. The patient experiences generalized malaise and muscle weakness, muscle pain, orthostatic hypotension, and vulnerability to cardiac dysrhythmias.

A patient has diabetes insipidus (DI). The LPN/LVN should anticipate giving which drug?

A. Cortisone B. Florinef C. Pitressin D. Insulin C. Pitressin Diabetes insipidus is managed by replacing fluid and electrolytes, along with hormone therapy, represents the basis of treatment of DI. In central DI, the hormone of choice to replace insufficient antidiuretic hormone (ADH) is desmopressin acetate (DDAVP), available orally, intravenously, or nasally. Other hormone medication choices exist, such as vasopressin (Pitressin) via nasal inhalation or by injection.

The nurse is caring for a patient with Graves' disease. Which finding would indicate a complication of this patient's disease process?

A. Extreme fatigue B. Tachycardia C. Shortness of breath D. Urinary frequency C. Shortness of breath Primary hyperthyroidism is also known as Graves' disease or toxic goiter. A patient with Grave's disease (hyperthyroidism) who experiences shortness of breath is most likely experiencing respiratory and cardiac complications of the disease. A patient with hypothyroidism, not hyperthyroidism, experiences extreme fatigue. Although a patient with Grave's disease does experience tachycardia, it is a symptom of the disease process, not a complication of it. Urinary frequency is not associated with Grave's disease.

The nurse is reviewing the history of a patient with suspected of having hyperthyroidism. Which manifestation(s) would be supportive of the diagnosis? (Select all that apply.)

A. Hyperactivity with increasing sense of fatigue B. Increase in appetite C. Emotional instability D. Mental sluggishness E. Heat intolerance A,B,C,E

A patient is scheduled for goiter excision. What is the priority nursing intervention during the patient's postoperative period?

A. Maintaining fluid and electrolyte balance B. Assessing airway patency C. Providing nutrition and fluids D. Managing pain adequately with narcotic analgesics B. Assessing airway patency A goiter is hyperplasia of the thyroid. Subtotal thyroidectomy may result in laryngeal spasms, making airway patency the clear priority. Although all other interventions listed here are necessary, they are lesser in priority than airway patency.

A patient who has hyperthyroidism has a nursing diagnosis of Anxiety related to nervousness and agitation. Because of this nursing diagnosis, which intervention should be included in the patient's care?

A. Maintaining the temperature of the room slightly above normal B. Keeping environmental stimuli to a minimum C. Stressing the importance of complying with treatment regimen D. Encouraging questions about options for treatment B. Keeping environmental stimuli to a minimum The patient with hyperthyroidism may experience nervousness and irritability. The patient will benefit from having the environmental stimuli kept to a minimum.

Which electrolyte is directly affected by the hormones secreted by the parathyroid?

A. Potassium B. Sodium C. Calcium D. Magnesium C. Calcium Parathyroid hormone (PTH) regulates serum calcium levels.

Immediately after a patient has a thyroidectomy, the patient should be placed in which position?

A. Trendelenburg B. Sims' left lateral C. Supine D. Fowler's D. Fowler's After a thyroidectomy, the patient is placed in the Fowlers position (sitting upright to at least 90 degrees) to facilitate breathing and reduce swelling of the operative area. The head may be supported with sandbags on either side to relieve tension on the sutures.

A patient with a pituitary tumor will most likely exhibit symptoms of:

A. alteration in visual acuity. B. frequent diarrhea. C. alterations in blood glucose. D. urticaria. A. alteration in visual acuity. Because of its location in the middle of the skull, adjacent to the optic nerve and brain, pressure on this area can cause an increase in intracranial pressure (ICP). As a pituitary tumor enlarges, ICP continues to increase. Common symptoms of increasing ICP are nausea, headache, vomiting, and decreasing visual acuity.

A patient with Cushing's disease should be instructed to:

A. avoid alcoholic beverages. B. limit dietary sodium. C. increase servings of dark green leafy vegetables. D. limit the amount of dietary protein. B. limit dietary sodium. Cushing's disease involves hyperadrenocortical secretion and a patient with Cushing's will retain sodium and water. Alcohol in moderation is allowed. There is no need to increase consumption of green leafy vegetables or protein.

Muscular twitching and cramps in the muscles following thyroidectomy may indicate:

A. damage to the parathyroid glands during surgery. B. early signs of epilepsy. C. damage to the cervical nerves. D. potassium depletion. A. damage to the parathyroid glands during surgery. Tetany actually results from injury to, or accidental removal of, the parathyroid glands. PTH is important in regulating body calcium and phosphorus levels, and a deficiency of PTH produces muscle cramps, twitching of the muscles, and, in some cases, severe convulsions. These symptoms represent a medical emergency and must be reported to the physician at once.

A patient is diagnosed as having Addison's disease. This condition is the result of:

A. excessive secretion of adrenocorticotropic hormone. B. insufficiencies of the mineralocorticoids and glucocorticoids. C. a secreting tumor of the adrenal cortex. D. overfunctioning of the pituitary and hypothalamus. B. insufficiencies of the mineralocorticoids and glucocorticoids. Addison's disease is characterized by decreased function of the adrenal cortex resulting in a deficit of all three hormones secreted by the adrenal cortex. The major problems are related to insufficiencies of the mineralocorticoids and the glucocorticoids.

A 42-year-old patient complains that she has been losing a lot of her hair, is fatigued, and is cold all the time. The LPN/LVN recognizes that these symptoms are indicative of:

A. hyperthyroidism. B. Correct hypothyroidism. C. hyperparathyroidism. D. hypoparathyroidism. B. hypothyroidism Hypothyroidism can be caused by inflammation of the thyroid gland (thyroiditis) or by treatment of hyperthyroidism that results in destroying too many thyroid cells and a resultant deficit of thyroid hormone.

The nurse is caring for a patient after a total thyroidectomy. The nurse's priority should be to:

A. maintain the patient in semi-Fowler's position, with her head back and neck supported by pillows. B. encourage the patient to turn her head side to side, to promote drainage of oral secretions. C. maintain the patient in a supine position, with sandbags placed on either side of her head and neck. D. encourage the patient to cough and deep-breathe every 2 hours, with her neck in a flexed position. A. maintain the patient in semi-Fowler's position, with her head back and neck supported by pillows. Following thyroidectomy, the patient should be placed in semi-Fowler's position to decrease swelling. Edema would exert pressure on the patient's airway, potentially compromising patency. Each of the other actions would increase the chances of postoperative complications, including bleeding, swelling, and airway obstruction.

A patient has been admitted for management of hypoparathyroidism. The nurse should anticipate an order for:

A. potassium. B. magnesium. C. calcium. D. iron. C. calcium. The parathyroid is responsible for calcium and phosphorus absorption. Patients with hypoparathyroidism develop hypocalcemia.

In the postoperative period, the LPN/LVN should observe a patient who has had a thyroidectomy for evidence of thyroid crisis. Two common signs of thyroid crisis are:

A. twitching of muscles and severe convulsions. B. extreme temperature elevation and rapid pulse rate. C. respiratory embarrassment and hoarseness. D. depression and fatigue. B. extreme temperature elevation and rapid pulse rate. Thyroid storm (TS), also known as thyroid crisis or thyrotoxicosis, is another complication following a thyroidectomy. In the postoperative setting, the condition is caused by a sudden increase in the output of thyroxine caused by manipulation of the thyroid as it is being removed. Another cause of TS may be improper reduction of thyroid secretions before surgery. The symptoms of TS are produced by a sudden and extreme elevation of all body processes. The temperature may rise to 106° F (41.1° C) or more, the pulse increases to as much as 200 beats per minute, respirations become rapid, and the patient exhibits marked apprehension and restlessness. Unless the condition is relieved, the patient quickly passes from delirium to coma to death from heart failure.