Hyper & hypothyroidism ?'s
A patient is prescribed levothyroxine, thyroid drug. The nurse understands that this drug contains which of the following? a. T3 b. iodine c. T4 d. Vitamin D
C T4
All of the following are common adverse effects of iodine solution drugs except: a. metallic taste b. mouth burning c. cold d. bradycardia e. diarrhea
D bradycardia is seen in thiomides
Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? "I will take this medication in the morning so as not to interfere with sleep." "I will double my dose if I gain more than 1 pound per day." "I will stop the medication immediately if I lose more than 2 pounds in a week." "I can expect to see relief of my symptoms within 1 week."
"I will take this medication in the morning so as not to interfere with sleep."
A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A) Do you feel any muscle twitches or spasms? B) Do you feel flushed or sweaty? C) Are you experiencing any dizziness or lightheadedness?
A Feedback: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
A patient with suspected hyperthyroidism is scheduled for a radioactive iodine uptake test. What symptoms of hyperthyroidism should the nurse note on the medical record? (Select all that apply.) a. Fatigue b. Tremor c. Weight loss d. Constipation e. Buffalo hump f. Cold intolerance
A B C
Side effects of thyroid drugs include: SELECT ALL THAT APPLY a. anxiety b. hypertension c. narcolepsy d. skin rash e. metallic taste in mouth
A, B thyroid drugs cause sleeplessness not narcolepsy skin rash and metallic taste are seen with ANTIthyroid drugs
Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm? a. Propranolol (Inderal) b. Propylthiouracil (PTU) c. Methimazole (Tapazole) d. Iodine (Lugol's solution)
ANS: A Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
A patient is exhibiting signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first? A. Total thyroxine (T4) B. Thyroid antibodies (Ab) C. Free triiodothyronine (FT3) D. Thyroid-stimulating hormone (TSH)
Answer: D Rationale: The most sensitive and accurate laboratory test is measurement of TSH, and it is often recommended as a first diagnostic test for evaluation of thyroid function. If the TSH is abnormal, the other laboratory tests may be ordered.
A nurse in a providers office is reviewing the health record of a client who is being evaluated for Graves' disease. Which of the following is an expected laboratory finding for this client? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid stimulating hormone C. Decreased free thyroxine index D. Decreased triiodothyronine
B. In the presence of Graves' disease, a low thyroid stimulating hormone (TSH) is an expected finding. The pituitary gland increases the production of TSH when thyroid hormone levels are elevated.
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hyponatremia B. Hypophosphatemia C. Hypocalcemia D. Hypokalemia
C
The nurse is caring for a patient following a thyroidectomy. What item is most important to have at the bedside? a. Hemostats b. Gauze dressings c. Tracheostomy set d. Suture removal kit
C
The primary function of the thyroid gland includes which of the following? a) Control of cellular metabolic activity b) Reabsorption of water c) Reduction of plasma level of calcium d) Facilitation of milk ejection
Control of cellular metabolic activity Explanation: The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
Mandatory testing in the newborn nursery determines that the infant has hypothyroidism. When discussing the treatment with the new mother, the mother states that she doesn't believe in taking medications. The nurse would explain that failure to treat the infant with the appropriate medication will result in: 1. Heart disease. 2. Mental retardation. 3. Renal failure. 4. Thyroid storm.
Correct Answer: 2 Rationale 1: If the hypothyroidism is left untreated, the child will experience bradycardia but will not develop heart disease. Rationale 2: Untreated hypothyroidism will lead to mental retardation. Rationale 3: Untreated hypothyroidism does not lead to renal failure. Rationale 4: Thyroid storm is a complication of hyperthyroidism, not hypothyroidism.
A nurse is approached by a neighbor who has a neck growth that appears to be a goiter. What should the nurse do? a. Advise the neighbor to switch to iodized salt when cooking. b. Palpate the neighbor's thyroid gland for enlargement or nodules. c. Ask if the neighbor has numbness or tingling in the hands or lips. d. Question the neighbor about symptoms of hypothyroidism or hyperthyroidism.
D
A patient is exhibiting signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first? A. Total thyroxine (T4) B. Thyroid antibodies (Ab) C. Free triiodothyronine (FT3) D. Thyroid-stimulating hormone (TSH)
D
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect? A) Anaphylaxis B)Nausea and vomiting C)Increased risk of drug interactions D)Prolonged duration of effect
D Feedback: In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.
The patient is receiving propylthiouracil (PTU), a thyomide. The nurse anticipates a reduction in the patients dosage based on assessment of which of the following? a. nervousness b. tachycardia c. weight loss d. decreased appetite
D decreased appetite PTU can cause thyroid suppression leading to s/s of hypothyroidism such as decreased appetite.
Cardiac effects of hyperthyroidism include which of the following? a) Decreased pulse pressure b) Bradycardia c) Palpitations d) Decreased systolic blood pressure
Palpitations Explanation: Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.
A nurse is assessing a client who is 12 hr post op following a thyroidectomy. Which of the following findings are indicative of thyroid crisis? A. Bradycardia B. Hypothermia C. Tremors D. Abdominal pain E. Mental confusion
Tremors: excessive levels of thread hormone can cause the client to experience tremors. Abdominal pain: when thread crisis occurs, the client can experience GI conditions, such as vomitting, diarrhea, and abdominal pain. Mental confusion: excessive thyroid hormone levels can cause the client to experience mental confusion.
Which of the following is thyroid drugs used for?SELECT ALL THAT APPLY a. hypothyroidism b. hyperthyroidism c. Grave's disease d. Myxedema coma e. emergency tx of thyrotoxicosis
a. hypothyroidism d. Myxedema coma
The nurse is caring for a patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. d. The patient makes harsh, vibratory sounds when breathing.
D
The nurse is caring for a patient with exophthalmos secondary to Graves' disease. What nursing interventions are appropriate for this patient? a. Myotic eyedrops and privacy b. Television and other diversionary activities c. An accepting attitude and lubricating eyedrops d. Reassurance that the symptoms will resolve when the Graves' disease is under control
D
A patient is diagnosed with hyperthyroidism. What should the nurse realize as being the most common cause of this disorder? a. Graves' disease b. Multinodular goiter c. Radiation exposure d. Excess thyrotropin-releasing hormone (TRH) from the hypothalamus
A
The nurse is caring for a patient following a thyroidectomy. Which postoperative assessment activity is most important to detect the development of thyrotoxic crisis? a. Monitor vital signs. b. Monitor the surgical dressing. c. Assess for confusion and delirium. d. Assess hand grips and foot presses.
A
The nurse is caring for a patient with a history of asthma who is newly diagnosed with hyperthyroidism. What assessment finding should the licensed practical nurse (LPN) report immediately to the registered nurse (RN)? a.Heart rate 112 beats/min b.Temperature 97.2°F (36.2°C) c.Blood pressure 112/73 mm Hg d.Respiratory rate 20 breaths/min
A
The nurse is caring for patients in a primary care physician office. Which patient should the nurse recognize as being the highest risk for iodine deficiency? a. A 52-year-old vegan with dietary sodium restrictions b. A 49-year-old with celiac disease who takes digoxin (Lanoxin) c. A 44-year-old lacto-vegetarian with a 40 pack-year smoking history d. A 28-year-old with lactose intolerance and a history of Graves' disease
A
23. A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? A) A 75-year-old female patient with osteoporosis B)A 50-year-old male patient who is obese C) A 45-year-old female patient who used oral contraceptives D)A 25-year-old male patient who uses recreational drugs
A Feedback: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women.
The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect? A) Fatigue B) Bulging eyes C) Palpitations D) Flushed skin
A Feedback: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.
A patient is suspected of having dilutional hyponatremia. What manifestations of this disorder should the nurse expect to observe in this patient? (Select all that apply.) a. Nausea b. Headache c. Constipation d. Weak, slow pulse e. Muscle weakness f. Elevated blood pressure
A B E F
Which of the following describe the therapeutic actions of antithyroid drugs? SELECT ALL THAT APPLY a. blocks synthesis of thyroid b. blocks conversion of T4 to T3 c. prevents oxidation of iodine d. blocks conversion of T3 to T4 e. initiates oxidation of iodine
A, B, C
A nurse in an intensive care unit is admitting a client who has myxedema coma. Which of the following should the nurse anticipate in caring for this client? Select all that apply. A. Observe cardiac monitor for inverted T-wave B. Observe evidence of urinary tract infection C. Initiate IV fluids using 0.9% sodium chloride D. Expect a prescription for levothyroxine IV bolus E. Provide warmth using a heating pad
A, B, C, D The client who has myxedema you may have a flat or inverted T-wave, as well as ST deviations; an infection such as a UTI, may precipitate myxedema coma; hyponatremia is a typical finding the presence of myxedema coma. Therefore, intravenous therapy is administered using either isotonic hypertonic fluids. Myxedema coma is a severe complication of hypothyroidism and can lead to come or death. Levothyroxine is administered IV bolus to treat the condition.
Hypothyroidism is a very common and often missed disorder. Signs and symptoms of hypothyroidism include: Select All That Apply a. increased body temperature b. thickening of the tongue c. bradycardia d. loss of hair e. excessive weight loss f. oily skin
A, B, D incr body temp thickening tongue loss of hair
A nurse in a providers office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole (Tapazole). Which of the following should the nurse include in the plan of care? Select all that apply. A. Monitor CBC B. Monitor T3 C. Inform the client that the medication should not be taken for more than three months D. Advise the client to take the medication at the same time every day E. Inform the client that an adverse effects of this medication is iodine toxicity
A, B, D Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Therefore, the nurse should monitor the clients CBC. Methimazole reduce his thyroid hormone production. And it should be taken the same time every day to maintain blood levels.
The nurse is preparing to receive a client from the PACU who is post operative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply. A. Suction equipment B. Humidified air C. Flashlight D. Tracheostomy tray E. 02 delivery equipment
A, B, D, E
The nurse is monitoring a client receiving levothyroxine sodium, thyroid drug, for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? SELECT ALL THAT APPLY a. insomnia b. weight loss c. bradycardia d. constipation e. mild heat intolerance
A, B, E
Which of the following are common side effects of thiomides? SELECT ALL THAT APPLY a. skin rash b. bradycardia c. diarrhea d. cold e. nausea
A, B, E diarrhea and cold are SE of iodine solution drugs
What are the uses of antithyroid drugs? SELECT ALL THAT APPLY a. emergency treatment of thyrotoxicosis b. to treat myxedema coma c. preparation for thyroid surgery d. Graves disease
A, C, D myxedema coma is treated with thyroid drugs via IV therapy. Its a coma brought on my hypOthyroidism
A client with hyperthyroidism has been given methimazole (a antithyroid med). Which nursing considerations are associated with this medication? SELECT ALL THAT APPLY a. Administer with food b. put client on low-calorie, low-protein diet c. assess for unexplained bruising or bleeding d. instruct client to report SE such as sore throat, fever and HAs e. use special radioactive precautions when handling the clients urine for the first 24 hours following initial administration
A,C, D
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake
ANS: B In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
ANS: B The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows.
ANS: C Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.
The LPN admits a well-known patient to the clinic and notes that the patient's face and features seem broader and coarser. Which laboratory test should the nurse expect to be prescribed for this patient? a. Cortisol b. Growth hormone c. Glucose tolerance test d. Vanillylmandelic acid (VMA)
B
Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg
ANS: C The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.
A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.
ANS: C There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
A patient with thyroid nodules is to undergo a thyroid scan with oral radioactive isotopes. Which instructions, if given by the nurse, are appropriate? A. "The test cannot be completed if you have an allergy to iodine or shellfish." B. "It is important to drink at least 2 to 3 liters of liquids for the next 1 to 2 days." C. "Isolation is required for 24 hours until the radioactive substance is eliminated from the body." D. "Sedation is necessary to ensure that you do not move while the scanner moves over your neck."
Answer: B Rationale: Patients should drink increased amount of fluids for 24 to 48 hours unless this is contraindicated. No special precautions are needed. The radionuclide will be eliminated in 6 to 24 hours. Reaction to iodine in allergic patients is rare because the amount of iodine in preparation is minimal. Sedation is not necessary for this procedure.
A patient 6 hours after a thyroidectomy has a temperature of 104°F, pulse 144 beats per minute, respirations 24 per minute, and blood pressure 184/108 mm Hg. Which orders should the nurse anticipate being prescribed for this patient? a. Aspirin and bedrest b. Beta blockers and a cooling blanket c. Epinephrine and compression dressings d. Diphenhydramine (Benadryl) and Fowler's position
B
After a thyroid scan, a patient is diagnosed with a hot nodule. What should this finding suggest to the nurse? a. The nodule is malignant and a thyroidectomy is necessary. b. The nodule is benign and may need a biopsy to confirm the diagnosis. c. The nodule is malignant and chemotherapy must be started immediately. d. The nodule is benign but will be treated with chemotherapy and radiation.
B
The nurse is preparing a patient for a thyroidectomy to treat hyperthyroidism. What patient statement indicates to the nurse that the patient understands the preoperative instructions? a. "I know that I should avoid turning my head after surgery." b. "I will probably need thyroid replacement medication after surgery." c. "I will avoid taking any thyroid or antithyroid drugs before surgery." d. "I will need to increase my calorie intake after surgery to avoid weight loss."
B
The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan? A) A clear liquid diet, high in nutrients B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and plant-sourced fat
B Feedback: A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the patients caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.
Which of the following would be the initial substance responsible for thyroid hormone regulation? a. iodine intake b. thyrotropin-releasing hormone c. thyroid-stimulating hormone d. Levothyroxine
B Initial substance for thyroid hormone release is thyrotropin-releasing hormone form the hypothalamus. It then stimulates TSH.
Administration of propylthiouracil would include giving the drug a. once a day in the morning b. around the clock to assure therapeutic levels c. once a day at bedtime to decrease adverse effects d. if the patient is experiencing slow heart rate, skin rash, or excessive bleeding
B Around the clock to assure therapeutic levels
The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention? A) Oral calcium chloride and vitamin D B) IV calcium gluconate C) STAT levothyroxine D) Administration of parathyroid hormone (PTH)
B Feedback: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.
The thyroid gland produces the thyroid hormones triiodothyronine (T3) and tetraiodothyronine (T4), which are dependent on the availability of a. iodine produced in the liver b. iodine found in the diet c. iron absorbed from the GI tract d. parathyroid hormone (PTH) to promote iodine building
B Iodine in the diet
Thyroid replacement therapy is indicated for the treatment of a. obesity b. myxedema c. Graves' disease d. acute thyrotoxicosis
B myxedema
Thyroid replacement therapy is indicated for the treatment of a. obesity b. myxedema c. Graves' disease d. acute thyrotoxicosis
B myxedema
The nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat hypothyroidism. Which of the following 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 serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.
B, C, D The provider carefully titrate the dosage of this medication. It should be increased to slowly until the client reaches an euthyroid state. Therefore the client should not discontinue the medication unless directed by PCP.
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings are expected with this condition? Select all that apply. A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness
B, C, E Abnormal menstrual periods, including menorrhagia and amenorrhea, are clinical manifestations of hypothyroidism. Dry skin and hoarseness are clinical manifestations of hypothyroidism.
A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply. A. Administering diuretics to prevent fluid overload B. Administering beta blockers to reduce heart rate C. Administering insulin to reduce blood glucose levels D. Applying interventions to reduce the patients temperature E. Administering corticosteroids
B, D Feedback: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following findings should the nurse include? Select all that apply. A. Dry skin B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
B, D, E Hyperthyroidism increases the client's metabolism. Therefore, heat intolerance, palpitations, and weight loss are expected findings.
A nurse is providing instructions to client who has Graves' disease and has a new prescription for propanolol (Inderal). Which of the following information should the nurse include? A. An adverse affects of this medication is jaundice. B. Take your pulse before each dose. C. The purpose of this medication is to decrease production of thyroid hormones. D. You should stop taking the medication if you have a sore throat.
B. Propanolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult his provider.
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response? A. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." B. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." C. "Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better." D. "Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland."
B. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."
The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue
C Feedback: Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.
6. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? A) Eggs B) Shellfish C) Table salt D) Red meat
C Feedback: The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient? A) Side-lying (lateral) with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowlers with the head supported on two pillows D) Supine, with a small roll supporting the neck
C Feedback: When moving and turning the patient, the nurse carefully supports the patients head and avoids tension on the sutures. The most comfortable position is the semi-Fowlers position, with the head elevated and supported by pillows.
Which of the following would the nurse expect to assess in a patient experiencing hyperthyroidism? a. slow and deep tendon reflexes b. bradycardia c. flushed, warm skin d. intolerance to cold
C flushed warm skin
Goiter, or enlargement of the thyroid gland, is usually associated with a. hypothyroidism b. iodine deficiency c. hyperthyroidism d. underactive thyroid tissue
C hyperthyroidism
The thyroid gland is dependent on the hypothalamic-pituitary axis for regulation. Increasing the levels of thyroid hormone (by taking replacement thyroid hormone) would a. increase hypothalamic release of thyrotropin-releasing hormone (TRH) b. increase pituitary release of thyroid-stimulating hormone c. suppress hypothalamic release of TRH d. stimulate the thyroid gland to produce more T3 and T4
C suppress hypothalamic release of TRH
A nurse in a providers office is reviewing the laboratory findings of the client who's being evaluated for primary hypothyroidism. Which of the following laboratory findings is expected for a client who has hypothyroidism? A. Serum T4 10 mcg/dL B. Serum T3 200 ng/dL C. Hematocrit 34% D. Serum cholesterol 100 mg/dL
C. Hematocrit of 34% indicates anemia, which is an expected result for a client who has hypothyroidism.
An adolescent female with untreated Graves' disease is admitted to the hospital. The nurse expects to find which signs and symptoms in this client? 1. Hyperglycemia, ketonuria, and glucosuria 2. Weight gain, hirsutism, and muscle weakness 3. Tachycardia, fatigue, and heat intolerance 4. Dehydration, metabolic acidosis, and hypertension
Correct Answer: 3 Rationale 1: Hyperglycemia, ketonuria, and glucosuria are signs of diabetes. Rationale 2: Weight gain, hirsutism, and muscle weakness are seen in clients with Cushing's disease. Rationale 3: Clinical manifestations of Graves' disease are tachycardia, fatigue, and heat intolerance, seen with hyperthyroidism. Rationale 4: Dehydration, metabolic acidosis, and hypertension are signs of congenital adrenal hyperplasia.
The nurse develops a nursing diagnosis of "fluid volume excess related to sodium retention secondary to steroid therapy as evidenced by weight gain of 12 pounds in 2 weeks and edema of lower extremities." Which goal is most appropriate? a. Patient will verbalize importance of low-sodium diet. b. Ankle circumference will be measured for edema daily. c. Patient's fluid volume will decrease as evidenced by discontinuing steroids. d. Patient will have improved fluid balance as evidenced by weight returning to baseline.
D
A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which statement should the nurse include when teaching the patient about this medication? a."If you do not take your medication, you will retain water and begin to see swelling in your feet and legs." b."Cushing's syndrome is a complication of severe hypothyroidism, so you need to take this medication regularly." c."Thyrotoxicosis results from too little thyroid hormone, so you should monitor your temperature every day." d."Worsening hypothyroidism can result in a condition called myxedema coma, so it is important to take this medication."
D
A patient recovering from a thyroidectomy is being assessed for tetany. What is the most likely cause of tetany after this surgery? a. Swelling of the incisional area b. Overdose of preoperative antithyroid medication c. Accidental removal of the parathyroid glands during surgery d. Excess circulating thyroid hormone released during manipulation of the gland during surgery
D
Assessing a patient's knowledge of his or her thyroid replacement therapy would show good understanding if he patient stated: a. "My wife may use some of my drug, since she wants to lose weight." b. "I should only need this drug for about 3 months." c. "I can stop taking this drug as soon as I feel like my old self." d. "I should call if I experience unusual sweating, weight gain, or chills and fever."
D
A patient is prescribed to ingest a high-calcium diet. What foods should the nurse instruct the patient to ingest? (Select all that apply.) a. Chicken b. Potatoes c. Beef and pork d. Sardines, salmon e. Milk, cheese, and yogurt f. Whole grain breads and cereals
D E
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: a) Hashimoto's thyroiditis. b) multinodular goiter. c) Graves' disease. d) thyroiditis.
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%).
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? a) Respiratory effects b) Parasympathetic c) Sympathetic d) Gastrointestinal effects
Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: a) TSH, triiodothyronine (T3), and calcitonin. b) thyrotropin-releasing hormone (TRH) and TSH. c) T3, thyroxine (T4), and calcitonin. d) iodine and thyroid-stimulating hormone (TSH).
T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient a. how to support the head with the hands when moving b. that coughing should due avoided to prevent pressure on the incision c. that the head and neck will need to remain immobile until the incision heals d. that any tingling around the lips or in the fingers after surgery is expected and temporary
a. how to support the head with the hands when moving (rationale- to prevent strain on the suture line postoperatively, the head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately.)
A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse a. explains that caloric intake must be reduced when drug therapy is started b. provides written instruction for all information related to the medication therapy c. assures the patient that a return to normal function will occur with replacement therapy d. informs the patient that medications must be taken until hormone balance is reestablished
b. provides written instruction for all information related to the medication therapy (rationale- because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)
When providing discharge instructions to a patient following a subtotal thyroidectomy, the nurse advises the patient to a. never miss a daily dose of thyroid replacement therapy b. avoid regular exercise until thyroid function is normalized c. avoid eating foods such as soybeans, turnips, and rutabagas d. use warm salt water gargles several times a day to relieve throat pain
c. avoid eating foods such as soybeans, turnips, and rutabagas (Rationale- when a patient has had a subtotal thyroidectomy, thyroid replacement therapy is not given, because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. However, the patient should avoid goitrogens, foods that inhibit thyroid, such as soybeans, turnips, rutabagas, and peanut skins. REgular exercise stimulates the thyroid gland and is encourage. Salt water gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.)
A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find a. hoarseness and laryngeal stridor b. bulging eyeballs and arrhythmias c. elevated temperature and signs of heart failure d. lethargy progressing suddenly to impairment of consciousness
c. elevated temperature and signs of heart failure (rationale- a hyperthyroid crisis results in marked manifestations of hyperthyroidism, with fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in the patient with Gravs' dz, it is not a significant factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
A patient with Grave's dz asks the nurse what caused the disorder. The best response by the nurse is a. "The cause of Grave's disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones" d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."
d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones." (rationale- The antibodies present in Graves' disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)
Causes of primary hypothyroidism in adults include a. malignant or benign thyroid nodules b. surgical removal or failure of the pituitary gland c. surgical removal or radiation of thyroid gland d. autoimmune-induced atrophy of the gland
d. autoimmune-induced atrophy of the gland (rationale- both Graves disease and Hasimotos thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure, and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.)
Physical changes of hypothyroidism that must be monitored when replacement therapy is started include a. achlorhydria and constipation b. slowed mental processes and lethargy c. anemia and increased capillary fragility d. decreased cardiac contractility and coronary atherosclerosis
d. decreased cardiac contractility and coronary atherosclerosis (rationale- hypothyroidism affects the heart in many ways, causing cardiomyopathy, coronary atherosclerosis, bradycardia, pericardial effusions, and weakened cardiac contractility. when thyroid replacement therapy is started, myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac arrhythmias, and heart failures. It is important to monitor patients with compromised cardiac status when starting replacement therapy.)