ATI Hypo / Hyperthyroidism 3 Nclex

A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? (Select all that apply.) A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness

B; Abnormal menstrual periods, including menorrhagia and amenorrhea, are manifestations of hypothyroidism. C; Dry skin is a manifestation of hypothyroidism. E; Hoarseness is a manifestation of hypothyroidism.

When nurse is educating a client, the nurse is likely to explain the following is the cause of Hashimoto's disease: Answers: A. Antibodies attacking the thyroid gland and cause Hypothyroidism B. Inflammation in the kidneys C. An adenocarcinoma in the brain D. Overactivation of the pituitary gland

A. Antibodies attacking the thyroid gland and cause Hypothyroidism.

A nurse in an ICU is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply.) A. Observe cardiac monitor for dysrhythmias B. Observe for evidence of urinary tract infection C. Initiate IV fluids using 0.9% sodium chloride D. Administer a levothyroxine IV bolus E. Provide warmth using a heating pad

A; A client who has myxedema can have a flat or inverted T wave as well as ST deviations. B; An infection (in the urinary tract) can precipitate myxedema coma. Observe the client for manifestations of infection so that the underlying illness can be treated. C; Hyponatremia is an expected finding in the presence of myxedema coma. IV therapy is administered using 0.9% sodium chloride. D; Myxedema coma is a severe complication of hypothyroidism that if left untreated can lead to coma or death. Levothyroxine is administered IV bolus to treat the condition.

A nurse in a provider's office is assessing a client who recently began taking levothyroxine to treat hypothyroidism. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech

A; Identify hand tremors as a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. Report this finding to the provider due to the possible need for a decrease in the dosage of medication.

A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Monitor CBC B. Monitor triiodothyronine (T3) C. Instruct the client to increase consumption of shellfish D. Advise the client to take the medication at the same time every day E. Inform the client that an adverse effect of this medication is iodine toxicity

A; Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Monitor CBC. B; Methimazole reduces thyroid hormone production. Monitor T3. D; Methimazole should be taken at the same time every day to maintain blood levels.

A nurse is preparing to receive a client from the PACU who is postop following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply.) A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray

A; The client can require oral or tracheal suctioning. Ensure that suctioning equipment is available. B; The client can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available. D; The client can experience respiratory obstruction. A tracheostomy tray should be available at the bedside.

A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following lab findings is expected? A. Elevated T4 B. Decreased T3 C. Elevated thyroid stimulating hormone D. Decreased cholesterol

B; Decreased levels of T3 in the blood is an expected finding for a client who has hypothyroidism.

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply.) A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia

B; Hyperthyroidism increases the client's metabolism, causing heat intolerance. D; Hyperthyroidism increases the client's metabolism, causing palpitations. E; Hyperthyroidism increases the client's metabolism, causing weight loss.

A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following lab results is an expected finding? A. Decreased thyrotropin receptor antibiodies B. Decreased thyroid-stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine

B; In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated.

A nurse is providing instructions to a client who has Grave's disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "An adverse effect of this medication is jaundice." B. "Take your pulse before each dose." C. " The purpose of this medication is to decrease production of thyroid hormone." D. " You should stop taking this medication if you have a sore throat."

B; Propranolol can cause bradycardia. The client should take their pulse before each dose. If there is a significant change, they should withhold the dose and consult the provider.

A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow-up blood TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation

B; The provider carefully titrates the dosage of this medication. It should be increased slowly until the client reaches a euthyroid state. The client should not discontinue the medication unless directed to do so by the provider. C; Blood TSH levels are used to monitor the effectiveness of the medication. D; The medication should be taken on an empty stomach to promote absorption.

Symptoms of Grave's ophthalmopathy include all of the following except: a. Bulging eyeballs b. Dry, irritated eyes and puffy eyelids c. Cataracts d. Light sensitivity

C. Cataracts

All of the following statements about Hashimoto's disease are true except: a. Many patients are entirely asymptomatic b. Not all patients become hypothyroid c. Most cases of obesity are attributable to Hashimoto's disease d. Hypothyroidism may be subclinical

C. Most cases of obesity are attributable to Hashimoto's disease.

A nurse is assessing a client who is 12 hr postop following a thyroidectomy. Which of the following findings is indicative of thyroid crisis? (Select all that apply.) A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion

C; Excessive levels of thyroid hormone can cause the client to experience dyspnea D; When thyroid crisis occurs, the client can experience GI conditions (vomiting, diarrhea, and abdominal pain). E; Excessive thyroid hormone levels can cause the client to experience mental confusion

A client with Graves' disease experiences a thyroid storm and has tachycardia and hypertension. What medication is most likely to be used? Answers: A. Levofloxcin B. Chlorothiazide C. Percocet D. Propylthiouracil

D. Propylthiouracil

Myxedema coma

Life threatening complication of untreated Hypothyroidism. Is usually triggered by acutely illness, infection, trauma, failure to take thyroid replacement meds, use of central nervous system depressant, and exposure to cold temperature. Myxedema is characterized by metabolic disorder (like hyponatremia, hypoglycemia, lactic acidosis); also, hypothermia, shallow edema usually around eyes, hand and feet; cardiovascular collapse, impaired mentation and coma. The treatment of Myxedema is: address precipitating factors and manifestation, maintain patent airway, maintain fluids, electrolytes, acid base balance, maintaining cardiovascular status, increase body temperature, and increase Thyroid Hormone level T3, T4. If myxedema coma left untreated, the mortality rate will be high.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? a. Increased appetite and weight loss b. Puffiness of the face and hands c. Nervousness and tremors d. Thyroid gland swelling

b. Puffiness of the face and hands.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany

b. Thyroid Crisis. Thyroid Crisis also called Thyroid Storm is an extreme untreated Hyperthyroidism (most often Graves Disease) or individuals with Hyperthyroidism that experienced stressors, like infection, trauma, untreated DKA, or manipulation of thyroid gland during surgery. The increase metabolic rate is due excessive TH T3,T4 which cause Thyroid storm. Manifestations are: Hyperthermia, tachycardia, systolic hypertension, GI symptoms like N/V, diarrhea, abdominal pain. Also, agitation, restlessness, tremors, confusion, psicosis, delirium, seizures. The mortality is really high. Cooling PT without ASPIRIN because increase free TH. Prevent shivering, replace fluids, glucose, electrolytes, relieve respiratory distress, stabilize cardiovascular function, and reduce Thyroid Hormone secretion. So low T3 and low T4.

An incoherent female 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, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Thyroid storm. b. Cretinism. c. myxedema coma. d. Hashimoto's thyroiditis.

c. Myexedema coma. 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 attack your Thyroid and often leads to an underactive Thyroid gland which cause Hypothyroidism.