UNIT 3 Hormonal Regulation Exemplar: Hyper/Hypothyroidism
A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1.Alleviate depression 2.Increase energy levels 3.Increase blood glucose levels 4.Achieve normal thyroid hormone levels
4 Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.
A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. What action does the nurse include when providing teaching about this drug? 1.Decreases the total basal metabolic rate 2.Maintains the function of the parathyroids 3.Blocks the formation of thyroxine by the thyroid gland 4.Decreases the size and vascularity of the thyroid gland
4 Potassium iodide aids in decreasing the size and vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary. Thyroid hormone substitutes regulate the body's metabolism. Maintaining the function of the parathyroids is not the therapeutic action of potassium iodine. The parathyroid glands help regulate adequate levels of calcium in the blood. When hypocalcemia occurs, the parathyroid glands increase the absorption of calcium from urine and the intestine and stimulate the breakdown of bone matrix, increasing the release of calcium from bone. Antithyroid drugs, not iodine, prevent the formation of thyroxine.
A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia
1,2,4,5 Thyroid storm is an acute and life-threatening complication that occurs in a client with uncontrollable hyperthyroidism. Signs and symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia
Levothyroxine 12.5 mcg orally each day is prescribed for a client with hypothyroidism. The pharmacy dispensed 90 tablets with each tablet containing 12.5 mcg. Six weeks later, the healthcare provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the tablets in the original prescription can be used before filling the new prescription. How many of the original tablets should the nurse instruct the client to take daily? Record your answer using a whole number. _____ tablets
2
Which finding for a pt. who has hypothyroidism should the nurse contact the HCP before giving Synthroid? - Elevated TSH - Increased thyroxine (T4) level - BP 112/62 - HR 60
Increased thyroxine (T4) level
Which assessment finding for a 33 y/o pt. dx with Grave's disease requires the most rapid intervention by the nurse? - Temperature 103.8 - BP 160/100 - HR 132 - Severe bilateral exophthalmos
Temperature 103.8
A neonate is diagnosed with hypothyroidism. The nurse discovers that the mother was receiving treatment for a thyroid disorder and continued the medication during pregnancy. Which drug might have caused hypothyroidism in the neonate? 1.Lithium 2.Androgens 3.Methimazole 4.Levothyroxine
3 Methimazole is used to treat hyperthyroidism and is contraindicated during pregnancy because its use may cause hypothyroidism in the neonate. Lithium may cause cardiac defects in a neonate. Androgens may cause masculinization of a female fetus. Used to treat hypothyroidism, levothyroxine is a safe drug to be taken during pregnancy.
What is a major nursing concern when caring for a client diagnosed with hyperthyroidism? 1.Monitoring for hypoglycemia 2.Protecting visitors and staff from radiation exposure 3.Providing foods to increase appetite 4.Arranging for sufficient rest period
4 Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.
A pt. post thyroidectomy develops laryngeal stridor & a cramp in the right hand upon returning to surg. unit. What should the nurse do next? - Plan for emergency tracheostomy - Suction the patient's airway - Prepare for endotracheal intubation - Administer IV Calcium gluconate
Administer IV Calcium gluconate
Which of the following patients should the nurse see first after given report? - Pt. with Addsion's dz. who takes hydrocortisone - Pt. diagnosed w/hyperthyroidism and apical rate 118 - Pt. with Cushing's syndrome and BG of 200 -Pt. post thyroidectomy and has a calcium level of 7.8
Pt. post thyroidectomy and has a calcium level of 7.8
A pt. is 6 hours post-op from thyroidectomy. Which position is best? - Fowlers - Prone - Trendelenberg - Semi-fowlers
Semi-fowlers
A prescription reads levothyroxine, 150 mcg orally daily. The medication label reads levothyroxine, 0.1 mg/tablet. The nurse administers how many tablet(s) to the client? Fill in the blank.
1.5 tablets You must convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000 or move the decimal 3 places to the left. Therefore, 150 mcg equals 0.15 mg. Next, use the formula to calculate the correct dose.
A client is taking an antithyroid medication for hyperthyroidism. The nurse provides education about serious health problems that may develop if the medication is not effective and tachycardia continues. The nurse instructs the client to seek medical attention immediately if any of the problems occur. Which should be included in the teaching? Select all that apply. 1.Diaphoresis 2.Weight gain 3.Flushed skin 4.Nervousness 5.Pedal edema
2,5 Weight gain is a sign of heart failure, which may develop with the persistent tachycardia that is present with hyperthyroidism; this should be reported to the health care provider immediately. Pedal edema is a sign of heart failure, which may develop with the persistent tachycardia that is present with hyperthyroidism; this should be reported to the health care provider immediately. Diaphoresis, flushed skin, and nervousness are expected to occur with hyperthyroidism and need not be reported immediately.
Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider? 1.A decreased dosage of levothyroxine 2.An increased dosage of levothyroxine 3.A decreased dosage of warfarin sodium 4.An increased dosage of warfarin sodium
3 Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.
The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1.Insomnia 2.Weight loss 3.Bradycardia 4.Constipation 5.Mild heat intolerance
1,2,5 Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.
The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply. 1.Tremors 2.Weight loss 3.Feeling cold 4.Loss of body hair 5.Persistent lethargy 6.Puffiness of the face
3,4,5,6 Feeling cold, hair loss, lethargy, and facial puffiness are signs of hypothyroidism. Tremors and weight loss are signs of hyperthyroidism
A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. 1.Use tinted glasses. 2.Use warm, moist compresses. 3.Elevate the head of the bed 45 degrees. 4.Tape eyelids shut at night if they do not close. 5.Apply a petroleum-based jelly along the lower eyelid.
1,3,4 Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly.
A pt. going home on Synthroid. Which statement from pt. would need more teaching? - "I will take Synthroid at bedtime with a snack." - " I will never stop taking Synthroid abruptly." - "If I have palpitations, chest pain, & intolerance to heat I will call MD." - " I will not take Synthroid at the same time with my iron tablet
"I will take Synthroid at bedtime with a snack."
A client is diagnosed with hyperthyroidism and is treated with I-131. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms should be included in the teaching? Select all that apply. 1.Fatigue 2.Dry skin 3.Insomnia 4.Intolerance to heat 5.Progressive weight gain
1,2,5 Fatigue is caused by a decreased metabolic rate associated with hypothyroidism. Dry skin most likely is caused by decreased glandular function associated with hypothyroidism. Progressive weight gain is associated with hypothyroidism in response to a decrease in the metabolic rate because of insufficient thyroid hormone. Insomnia is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone. Intolerance to heat is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone.
A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1.Administer methimazole with food. 2.Place the client on a low-calorie, low-protein diet. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5.Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.
1,3,4 Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the primary health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.
A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply. 1.Cool skin 2.Photophobia 3.Constipation 4.Periorbital edema 5.Decreased appetite
1,3,4,5 Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edemas are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.
A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1.Hoarseness 2.Hypocalcemia 3.Audible stridor 4.Edema at the surgical site
3.Audible stridor Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.
The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1.Fatigue 2.Tremors 3.Cold intolerance 4.Excessively dry skin
2 Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the PHCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.
A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure? 1.Remain in the house. 2.Avoid holding an infant. 3.Save urine in a lead-lined container. 4.Refrain from using a bathroom used by others
2 Infants are particularly sensitive to radioactivity; even the small amount emitted after treatment may affect infants. It is not necessary to avoid leaving the house as long as close proximity to others is avoided. Saving urine in a lead-lined container is not necessary; the same bathroom may be used by all members of the family, but the toilet should be flushed twice after use by the client. Refraining from using a bathroom used by others is not necessary.
A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? 1.Iodide solutions must be diluted in water and taken on an empty stomach. 2.Monitoring for signs of infection or bleeding is necessary. 3.Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy. 4.These drugs will be discontinued as soon as the temperature and pulse rate return to the expected range.
2 Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.
The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1.Provide a cool environment for the client. 2.Instruct the client to consume a high-fat diet. 3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 5.Inform the client that iodine preparations will be prescribed to treat the disorder. 6.Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.
3,4,6 The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.
A 17-year-old female who reports irregularity of menses and weight loss is diagnosed with hypothyroidism. Which type of menstrual disorder does this client have? 1.Primary amenorrhea 2.Primary dysmenorrhea 3.Secondary dysmenorrhea 4.Hypogonadotropic amenorrhea
4 Hypogonadotropic amenorrhea may be due to an interruption in the hypothalamic pituitary axis; this disruption results in endocrine disorders such as hypothyroidism and absence of menstruation. Primary amenorrhea is the absence of menses by 16.5 years regardless of normal growth and development. Dysmenorrhea, primary or secondary, is pain before or during menstruation.
#1 priority post thyroid surgery
AIRWAY
Propylthiouracil is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get radiation therapy?" What explanation does the nurse provide? 1.It binds previously formed thyroid hormones. 2.It decreases production of thyroid hormones. 3.Vascularity of the thyroid gland is decreased. 4.The need for thyroid iodine supplements is reduced.
2 Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.
A nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy? 1.Free thyroxine (FT 4) 2.Thyroxine (T 4), total 3.Free triiodothyronine (FT 3) 4.Triiodothyronine (T 3), total
2 The thyroxine (T 4) total study is the best method of monitoring thyroid therapy. A free thyroxine (FT 4) study measures the active component of total T 4; this test is an indicator of thyroid function. Free triiodothyronine (FT 3) measures the active component of triiodothyronine (T 3) total. Total T 3 helps to diagnose hyperthyroidism when T 4 levels are normal.
A client with hyperthyroidism has been treated with radioactive iodine ( 131I) to destroy overactive thyroid gland cells. To reduce radiation exposure, the nurse's principles for providing care should be based on what? 1.Wearing a lead-shield apron at all times 2.Limiting distance and time spent with the client 3.Wearing a radiation meter to measure exposure 4.Remaining at least 6 feet (1.8 m) away from the client at all times
2 When caring for clients who are radioactive, the three most important concepts for reducing radiation exposure are to limit exposure time, increase distance, and use shielding. In this situation, time and distance provide the best reduction in radiation exposure. Wearing a lead-shield apron will help prevent radiation exposure, but time and distance are the first priorities. A radiation meter measures exposure, but does nothing to protect caretakers. Remaining at least 6 feet (1.8 m) away from the client at all times is not a practical approach.
A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? 1.Warm the client. 2.Maintain a patent airway. 3.Administer thyroid hormone. 4.Administer fluid replacement.
2. Maintain a patent airway. Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.
A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response? 1.Hypothyroidism is a gradual slowing of the body's function. 2.A decrease in pituitary thyroid-stimulating hormone (TSH) will occur. 3.Less thyroid tissue is available to supply thyroid hormone after surgery. 4.Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones.
3 After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy.
A client with hyperthyroidism is to receive methimazole. What instructions does the nurse provide? 1.Initial improvement will take several weeks. 2.There are few side effects associated with this drug. 3.This medication may be taken at any time during the day. 4.Large doses are used to quickly correct the functions of the thyroid.
1 Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy.
The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? Select all that apply. 1.Emotional lability 2.Dyspnea on exertion 3.Abdominal distention 4.Decreased bowel sounds 5.Hyperactive deep tendon reflexes
1,2,5 Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurologic manifestation related to excessive production of thyroid hormones. Abdominal distention is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.
Which parameter monitoring should be the nurse's priority while caring for a client with hypothyroidism? 1.Pulse rate 2.Blood pressure 3.Respiratory rate 4.Body temperature
3 Hypothyroidism is associated with a decreased respiratory rate. Therefore monitoring the client's respiratory rate should be the nurse's top priority. While hypotension, hypothermia, and pulse rate are important, they are not the priority.
Which neurologic manifestation in a client is associated with hyperthyroidism? 1.Confusion 2.Hearing loss 3.Exophthalmos 4.Slowness of speech
3 In hyperthyroidism, edema in the extraocular muscles and increased fatty tissue behind the eye leads to exophthalmos. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism.
The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1.With food 2.At lunchtime 3.On an empty stomach 4.At bedtime with a snack
3 Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.
