myxedema, Grave's and Disease

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

A, D

2. As the nurse educating the patient about Grave's Disease, which of the following statements by the patient ensures the patient understood the education about their condition? A. "I could experience myxedema coma, which is life-threatening, if I abruptly stop taking my antithyroid medication." B. "Grave's disease is due to an excessive amount of thyroid hormone in the body." C. "I will be sure to eat a lot of kelp because it helps with decreasing thyroid hormone levels." D. "If I have pain I will only take aspirin."

Answer is B. Option A is wrong because myxedema coma is a complication of HYPOthyroidism, and if the patient abruptly stops taking their antithyroid medication they are at risk for THYROID STORM. Kelp (seaweed) and Aspirin should be avoided in Grave's disease because they both cause increased T3 and T4 production.

. 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.

All of the following are treatments for myxedema coma EXCEPT? A. Corticosteroids B. IV glucose C. Hypotonic IV solutions D. IV Synthroid

HYPERtonic or normal saline solutions are used to treat myxedema coma due to the present of hyponatremia....not HYPOtonic solutions.

3. 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

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.

Which of the following are not a treatment for Thyroid Storm? A. Propylthiouracil (PTU) B. Synthroid C. Inderal D. Glucocorticoids

Synthroid is a medication treatment for HYPOthyroidism. All the other options are for HYPERthyroidism.

7. A patient is started on Tapazole (Methimazole) for treatment of Grave's Disease. Which statement by the patient indicates they understood your teaching about this medication? A. "If I experience fast heart, excessive sweating, or fever, I will notify the doctor immediately because I may be experiencing toxicity of the medication." B. "I know it may take a while before I feel relief of symptoms, therefore, I will never abruptly stop taking my medication." C. "This medication can cause high blood glucose." D. "I will make sure my diet is rich in foods containing iodine."

The answer B. Toxicity of Tapazole (an antithyroid medication) would include bradycardia, hypothermia, hypotension (signs and symptoms of HYPOthyroidism) etc. This medication is not known to cause high blood glucose, and the patient should avoid foods high in iodine because this causes an increased production of thyroid hormones.

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.

3. A patient is post-opt from a thyroidectomy for treatment of Grave's Disease. When you walk into the patient's room to perform an assessment, which of the following findings causes the MOST concern and needs nursing intervention? A. The patient complains of a pain rating of 4 on 1-10 at the surgical site. B. The patient is positioned in supine position. C. The patient's Foley catheter is draining 50 cc of urine per hour. D. The patient is splinting the neck while coughing and deep breathing.

The answer is B. The MOST concerning option is that the patient is in the supine position. The patient should be in SEMI-FOWLER'S position after a thyroidectomy to prevent excessive swelling/bleeding and pressure on the site.

5. A patient is being treated for Grave's Disease. They have a health history of type 1 diabetes, breast cancer, eczema, and hypertension. The physician orders Inderal. What important information will you include in their discharge teaching about this medication? A. Importance of taking the medication only as needed for symptoms. B. Avoid aged cheeses and wines while taking this medication. C. Monitor blood glucose levels closely because this medication can mask the signs and symptoms of hypoglycemia. D. Monitor heart rate regularly because this medication will increase the heart rate.

The answer is C. Inderal is a beta-blocker which can cause masking of hypoglycemia in diabetic patients. Therefore, the patient must monitor blood glucose levels closely while taking this medication to treat Grave's Disease.

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 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.

. A patient is receiving radioactive iodine as treatment for Grave's Disease. Which of the following are common side effects of the treatment? Select all that apply: A. Nausea B. Taste changes C. Excessive saliva D. Swollen salivary glands

The answers are A, B, and D.

6. Select all that apply: Which of the following are signs and symptoms of Grave's Disease: A. Heat Intolerance B. Weight gain C. Bradycardia D. Goiter E. Pretibial Myxedema F. Cold intolerance G. Ophthalmopathy changes H. Fast Heart Rate

The answers are A, D, E, G, and H. The only options that are NOT signs and symptoms of Grave's disease are: weight gain, bradycardia, and cold intolerance....these are S & S of HYPOthyroidism

4. 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 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.

Which of the following statements are CORRECT about Grave's Disease? A. Grave's Disease is caused by independently functioning nodular goiters producing excessive amounts of T3 and T4. B. Grave's Disease is a complication of untreated hypothyroidism. C. Grave's Disease is caused by an autoimmune condition where the body produces an antibody called TSI (which acts like TSH on the body). D. Grave's Disease patients do not present with protruding eyes or a goiter, as in Toxic Nodular Goiter (TNG).

c

ugol'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

c

5. 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

he answer is A, B, C, D. Foods high in iodine are seafoods like shrimp, seaweed, and dairy/eggs.

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

he 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 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

he answer is C. 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).

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 headach

patient who has hyperthyroidism or thyroid storm should NEVER take salicylate (ex: aspirin) because it canincrease thyroid hormones. All the other options are correct or insignificant for why the patient is taking the medication.