PrepU Chapters 31,36,37 Pellico

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Sodium Calcium Potassium Magnesium

Calcium Explanation: Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? D C B E

D Explanation: The actions of PTH are increased by the presence of vitamin D.

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

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

When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following? Inadequate secretion of parathormone Increase in serum calcium Lowered blood phosphate Increase in the renal excretion of phosphate

Inadequate secretion of parathormone Explanation: In hypoparathyroidism, there is an increased blood phosphate. Blood calcium is decreased, and there is a decreased renal excretion of phosphate. The secretion of parathormone is inadequate.

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? Complaints of sleepiness Thick hard nails Inability to tolerate cold Reports of increased appetite

Reports of increased appetite Explanation: Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.

A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. Urine specific gravity of 1.001 Serum ADH level of 2.3 pg/mL Serum osmolality of 310 mOsm/kg Urine osmolality of 800 mOsm/kg Serum sodium level of 149 mEq/L

Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L Explanation: All are indicative of diabetes insipidus, except for B and D, which are normal results. Refer to Table 31-1.

For a client with hyperthyroidism, treatment is most likely to include: a thyroid hormone antagonist. thyroid extract. a synthetic thyroid hormone. emollient lotions.

a thyroid hormone antagonist. Explanation: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: thyroid storm. cretinism. myxedema coma. Hashimoto's thyroiditis.

myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

When providing teaching to a client with hyperthyroidism that is prescribed radioactive iodine (RAI) to destroy thyroid tissue, which of the following would the nurse include? Radioactive iodine (RAI) has no adverse effects. Its effect is not apparent until the gland has secreted excess thyroid hormone. RAI does not seriously affect other tissues. The process may take several weeks or more.

RAI does not seriously affect other tissues. Explanation: The nurse should inform the client that RAI does not seriously affect other tissues when it is used to destroy thyroid tissue. RAI is associated with possible transient effects including nausea, vomiting, malaise, fever, and gland tenderness. The effects of antithyroid therapy are not apparent until the thyroid gland has secreted the excess thyroid hormone into the bloodstream and may take several weeks or more.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? Calcium gluconate Synthroid Propylthiouracil (PTU) Tapazole

Calcium gluconate Explanation: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test? Serum immunoassay for TSH Fine-needle biopsy of the thyroid gland Free T4 analysis Ultrasound of the thyroid gland

Fine-needle biopsy of the thyroid gland Explanation: Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? Gigantism Dwarfism Acromegaly Simmonds' disease

Gigantism Explanation: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: thyroiditis. Graves' disease. Hashimoto's thyroiditis. multinodular goiter.

Graves' disease. Explanation: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hypocalcemia Hypercalcemia Hyperphosphatemia Hypophosphaturia

Hypercalcemia Explanation: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? Positive Trousseau's sign Positive Chvostek's sign Hyperactive deep tendon reflex Tetany

Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? "Maintain a moderate exercise program." "Rest as much as possible." "Lose weight." "Jog at least 2 miles per day."

"Maintain a moderate exercise program." Explanation: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.

The nurse assesses the laboratory values for a patient with SIADH. Which of the following are consistent with this diagnosis? Select all that apply. Serum sodium of 143 mEq/L Serum osmolality of 270 mOsm/kg Urine sodium of 30 mEq/L Urine osmolality of 1,500 mOsm/kg

Serum osmolality of 270 mOsm/kg Urine sodium of 30 mEq/L Urine osmolality of 1,500 mOsm/kg Explanation: SIADH manifestations include hyponatremia (serum sodium <134 mEq/L), decreased serum osmolality (<280 mOsm/kg), increased urine osmolality (>800 mOsm/kg), and urinary sodium of over 20 mEq/L.

A nurse should expect a client with hypothyroidism to report: increased appetite and weight loss. puffiness of the face and hands. nervousness and tremors. thyroid gland swelling.

puffiness of the face and hands. Explanation: Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).