Thyroid

The nurse is seeing four clients today in the endocrinology clinic. Which client would the nurse expect to be at highest risk for Hashimoto disease? A) A 40yo woman with a goiter B) A 60yo African-American man C) A 10yo child with congenital hypothyroidism D) A 50yo man with hypothyroidism

A) A 40yo woman with a goiter Rationale: Hashimoto disease occurs twice as often in women as in men. The disorder is not commonly seen in​ children, and it is not more commonly seen in African Americans than in other ethnic groups.

The nurse is providing care for a young adult client with exophthalmos. Which nursing diagnosis would be the most appropriate for this client? A) Disturbed Body Image B) Ineffective Coping C) Risk for Injury D) Activity Intolerance

A) Disturbed Body Image Rationale: Exophthalmos is a clinical manifestation associated with hyperthyroidism and may be a problem for a young client. The nurse would plan to assess self-esteem and make appropriate referrals. Activity intolerance and risk for injury are not particular to this medical diagnosis. The client's ability to cope could be an issue, but it would probably stem from the disturbed body image.

Increasing circulating levels of TH heighten the sympathetic nervous system's physiologic responses to stimulation. What effect does this have on the cardiac system? A) Increases stroke volume B) Decreases cardiac rate C) Lengthens the QRS interval D) Decreases BP

A) Increases stroke volume Rationale: The sensitizing effect of abnormally elevated thyroid hormone levels increases the cardiac rate and stroke volume. As a result, cardiac output and peripheral blood flow increase. The increased cardiac rate would result in a shortened QRS interval. Stimulation of the sympathetic nervous system increases blood pressure.

Which nursing intervention is most appropriate for a client experiencing a thyroid storm? A) Padding the side rails B) Cooling the client C) Replacing lost fluids D) Administering anti-thyroid medication

A) Padding the side rails Rationale: The client experiencing a thyroid storm is at high risk for developing seizures.​ Therefore, the nurse would promote safety by padding the side rails. Cooling the​ client, replacing lost​ fluids, and administering antithyroid medications are appropriate interventions to treat the disorder but are not related to promoting client safety.

The nurse is teaching an older adult client how to manage Graves disease. Which information should the nurse include? A) The administration schedule for an antithyroid drug B) Preparation for surgical removal of the thyroid C) Use of levothyroxine (Synthroid) and lab monitoring D) The schedule for lifelong radioactive iodine treatments

A) The administration schedule for an antithyroid drug Rationale: Hyperthyroidism in the older adult is usually managed with the administration of antithyroid drugs and then evaluation to determine if radioactive iodine treatments are necessary. Thyroidectomies are not usually performed in older adults due to preexisting cardiac and central nervous system disorders. Levothyroxine​ (Synthroid) and lab monitoring are used to treat hypothyroidism.

The nurse in the fertility clinic is working with a female client who has had repeated miscarriages. Which information in the client's history may be a precipitating factor? A) Uncontrolled hypothyroidism B) History of toxic multi-nodular goiter C) Type 2 Diabetes D) Hyperemesis gravidarum

A) Uncontrolled hypothyroidism Rationale: Uncontrolled hypothyroidism can lead to​ miscarriages, stillbirths,​ preeclampsia, and low birth weights. Type 2 diabetes mellitus can lead to newborns that are large for gestational age. Hyperemesis gravidarum can cause hyperthyroidism in pregnancy. A history of toxic multinodular goiter would not cause repeated miscarriages later in life.

*Possible Exam Question* Which priority should the nurse include in a teaching plan for a client with Graves disease? SATA A) Take antithyroid drugs as prescribed B) Weigh yourself daily C) Drink 6 to 8 glasses of water a day D) Tape your eyelids closed at night E) Eat a low-cal diet

A, B, C, D Rationale: The client is prescribed an antithyroid medication such as​ propylthiouracil, which must be taken as prescribed. Due to weight​ loss, the weight is carefully monitored. Due to​ exophthalmos, the client must protect the​ eyes, apply eye​ drops, wear sunglasses when​ outside, and tape them closed at night. The client has a decreased appetite and weight loss. A​ high-calorie diet is recommended. The client may have frequent​ diarrhea, and maintaining hydration is a priority.

*Possible Exam Question* Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible hyperthyroidism? SATA A) Weight loss B) Deep tendon reflexes C) Vital signs D) Confusion E) Vision test

A, B, C, E Rationale: Hyperthyroidism may affect many systems in the​ body, and the nurse would include the weight of the client in the physical​ assessment, a vision​ test, vital​ signs, and a test of the tendon reflexes. Confusion is associated with hypothyroidism.

*Possible Exam Question* The nurse is teaching a group of adults at a community health fair about hypothyroidism. Which risk factor should the nurse include in the presentation? SATA A) Autoimmune disease B) Thyroid surgery C) Radiation of the neck D) Male sex E) Radioactive iodine treatment

A, B, C, E Rationale: Risk factors for hypothyroidism include having an autoimmune​ disease, having a family member with an autoimmune​ disease, previous treatment with radioactive​ iodine, radiation of the​ neck, thyroid​ surgery, and female sex.

The nurse is caring for a client newly diagnosed with Graves disease. The client asks the nurse go the goiter occurred. Which factor should the nurse include in the response? SATA A) Antibodies bind to the TSH's B) The client's tissues form antibodies C) The thyroid cells become hypoactive D) They thyroid gland enlarges E) The client's tissues form antigens

A, B, D Rationale: Goiters can occur when the thyroid gland produces either too much thyroid hormone or not enough. Antibodies bind to the​ thyroid-stimulating hormones​ (TSH) in the thyroid follicles. As the gland​ enlarges, a goiter develops. The thyroid cells become hyperactive. The tissues form​ antibodies, not antigens.

Which manifestation should the nurse monitor when caring for a client on TH replacement therapy? SATA A) Report of dizziness B) Improvement of symptoms of hypothyroidism C) Decrease in appetite D) Symptoms of hyperthyroidism E) Stable vital signs

A, B, D, E Rationale: Vital signs should be assessed on every​ client, and those receiving TH replacement should be assessed for symptoms related to blood levels. Monitor improvement of symptoms. Dizziness and lack of sleep are some symptoms to report. The client would be expected to have an​ increase, not​ decrease, in appetite. If the client begins to experience symptoms of​ hyperthyroidism, it could indicate that the medication dose needs to be adjusted.

The nurse is caring for a newborn diagnosed with hyperthyroidism after birth. Ongoing assessments during the first year of life should be conducted to monitor for which alteration? SATA A) Respiratory difficulties B) Premature fontanelle closure C) Bradycardia D) Non-palpable thyroid gland E) Heart failure

A, B, E Rationale: An infant with hyperthyroidism would have higher metabolic​ rates, leading to tachycardia and heart failure. The infant may develop respiratory difficulties from an enlarged thyroid pressing on the trachea. The fontanelles will also close prematurely. The thyroid gland will be palpable.

A nurse is caring for an adult client recently diagnosed with hypothyroidism. After reviewing the nursing admission assessment, on which documented findings should the nurse plan care for this client? SATA A) Hypothermia B) Hot flashes C) Nausea D) Constipation E) Tachycardia

A, D Rationale: Hypothyroidism is often accompanied by hypothermia and constipation, among other symptoms. Hot flashes, tachycardia, and nausea are not symptoms of hypothyroidism.

A client with a family hx of hyperthyroidism asks the nurse, "What can increase my risk of developing this disorder?" Which response by the nurse is accurate? A) "Arthritis can lead to the development of hyperthyroidism." B) "Viral infections can cause the onset of hyperthyroidism." C) "Smoking can increase your risk for acquiring this disease." D) "Invasive neck surgery can impact thyroid functioning."

B) "Viral infections can cause the onset of hyperthyroidism." Rationale: A viral infection can increase the risk of hyperthyroidism. Other risks include having an autoimmune​ disease, pregnancy, female​ sex, and being under the age of 40. Surgery in the neck area increases the risk of hypothyroidism. Smoking and arthritis are not risk factors for hyperthyroidism.

A client with hyperthyroidism is scheduled for surgery in a few day. Which collaborative intervention would address cardiovascular symptoms that may prevent the client from undergoing the procedure? A) Nothing, because there is little effect on the quality of life in older adults B) Administration of anti-thyroid medications with propranolol C) The ingestion fo RAI D) A combination treatment with levothyroxine (Synthroid) and amiodarone (Cordarone)

B) Administration of the antithyroid medications with propranolol Rationale: Cardiovascular symptoms can be decreased rapidly by adding a beta-blocker, such as propranolol, to initial treatment with antithyroid medications. Levothyroxine increases thyroid hormone levels, so it would not be helpful for this client. Radioactive iodine treatment takes several weeks to take effect, and it doesn't directly address cardiovascular symptoms.

The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? A) Lethargy B) Irritability C) Weight gain D) Feeling Cold

B) Irritability Rationale: levothyroxine can cause: hyperactivity, weight loss, heat sensitivity and excessive sweating

The nurse is preparing an education session for nurses who work in an endocrinology clinic caring for older adult clients. Which statement about the thyroid should the nurse include in her teaching? A) Thyroid hormone is often increased for older adult clients B) Symptoms of hypothyroidism in this group of clients are often confused with symptoms of aging C) Hypothyroidism is a congenital disease that manifests in older adult clients D) Hypothyroidism presents with pitting edema for this group of clients

B) Symptoms of hypothyroidism in this group of clients are often confused with symptoms of aging Rationale: The nurse educator must emphasize that the diagnosis is often missed for this group of clients as the clinical manifestations are confused with symptoms of aging. Not all hypothyroidism is congenital, and it is inaccurate to state that older adult clients develop the disease due to congenital defects. Thyroid hormone is decreased in all clients with hypothyroidism. The older adult client will present with nonpitting edema.

A heel-stick screening of a newborn reveals the presence of T4 deficiency along with elevated TSH. The infant is diagnosed with hypothyroidism. Which information should the nurse provide the parents? A) The child will be involved in infertility treatment later in life B) The child will need lifelong thyroid medication supplementation C) The child will require evaluation for radioactive iodine D The child will eventually grow out of this and no longer need treatment

B) The child will need lifelong thyroid medication supplementation Rationale: Hypothyroidism detected in neonates requires lifelong supplementation of thyroid hormone. The drug of choice for children is oral levothyroxine. The child would not require radioactive​ iodine, as this is reserved for hyperthyroidism. Infertility is a possibility for those women with hypothyroidism who do not ovulate. The child will not grow out of​ this, and will need lifelong treatment.

The nurse reviews the laboratory results for a client notes that the T4 level is low. Which prescription should the nurse anticipate the HCP to prescribe? A) Beta blocker B) Thyroid replacement C) Antithyroid medications D) RAI

B) Thyroid replacement Rationale: The treatment of choice for hypothyroidism is the thyroid hormone replacement​ drug, levothyroxine.​ Therefore, the nurse would expect the healthcare provider to prescribe this medication. Radioactive iodine and antithyroid medications are used in the treatment of hyperthyroidism. A beta​ blocker, such as​ propranolol, is used to lower the heart rate in clients with hyperthyroidism.

*Possible exam question* The nurse is preparing a client with hyperthyroidism for RAI treatments. Which information should the nurse provide to the client prior to this procedure? SATA A) That hospitalization is usually required B) That the client may need lifelong thyroid replacement C) How to measure the radial pulse D) That RAI is given intravenously E) That the end results are immediately seen

B, C Rationale: Clients are instructed on measuring their own pulse until stores of thyroid hormone are depleted and notifying the healthcare provider if the heart rate is over 100 beats per minute. The client will more than likely require lifelong thyroid replacement due to radiation effects on the remaining thyroid tissue. The results may take up to 6 to 8 weeks to notice. This procedure is performed with an oral contrast on an outpatient basis.

A client with Graves disease requests that the nurse explain the results of recent laboratory tests. Which results would the nurse anticipate discussing with the client? SATA A) An increase in TSH levels B) An increase in thyroid antibodies C) A decrease in T4 D) An increase in T3 E) A decrease in T3 uptake

B, D - Increase in thyroid antibodies - Increase in T3 levels Rationale: Graves disease, or primary hyperthyroidism, has alterations in normal lab work. With this condition, TSH levels are decreased. Thyroid antibodies, serum T4, serum T3, and T3 uptake tests are all increased.

The nurse is teaching colleagues about hyperthyroidism. Which statement by a colleague indicates understanding of an indication for a thyroidectomy? SATA A) "The client may require thyroidectomy for cosmetic reasons, such as a large goiter." B) "A thyroidectomy may be performed if the thyroid is placing pressure on the esophagus." C) "The client will not need surgery as long as she takes anti-thyroid medication." D) "A thyroidectomy may be performed if the thyroid is compromising the airway." E) "A total thyroidectomy is performed to treat cancer of the thyroid."

B, D, E Rationale: A total or partial thyroidectomy may be necessary to treat a thyroid that is placing pressure on the esophagus or obstructing the​ client's airway. Thyroid cancer can also be treated by a thyroidectomy. A goiter is not removed for purely cosmetic​ reasons; it is removed for hypothyroidism that produces too much​ thyroid-stimulating hormone. This can cause a potentially​ life-threatening condition called myxedema.

A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? A) "PTU causes the pituitary gland to secrete TSH, which blocks the production of hormones by the thyroid gland." B) PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." C) "PTU inhibits the formation of new TH, thus returning your metabolism to normal." D) "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."

C) "PTU inhibits the formation of new TH, thus returning your metabolism to normal." Rationale: PTU is an antithyroid medication; thus it inhibits TH production

The client with hypothyroidism asks the nurse why the TSH level is increased if the thyroid is not working properly. Which response by the nurse is accurate? A) "Your TSH level is increased because the thyroid is working harder to produce more hormone." B) "Your TSH level is increased due to an increase in metabolism noted in clients with hypothyroidism." C) "Your TSH level is increased due to an inadequately functioning negative hormonal feedback process." D) "Your TSH level is increased from a malfunction in the hypothalamus, leading to thyroid insufficiency."

C) "Your TSH level is increased due to an inadequately functioning negative hormonal feedback process." Rationale: The TSH level increases in clients with hypothyroidism due to a loss of the negative hormonal feedback​ system, not because the thyroid is working harder. Metabolism is decreased in​ hypothyroidism, not increased. The pituitary​ gland, not the​ hypothalamus, is responsible for TSH production.

Which client is at the greatest risk for developing hypothyroidism? A) A 21-year-old woman who has a mother with Graves disease B) A 32-year-old man who has an uncle with type 1 diabetes mellitus C) A 57-year-old woman whose aunt had systemic lupus erythematosus D) A 72-year-old man whose father had cardiovascular disease

C) A 57yo woman whose aunt has systemic lupus erythematosus Rationale: Risk factors for hypothyroidism include being a woman over the age of 50, having a close relative with an autoimmune condition, and having treatment for a thyroid disorder. The 57-year-old woman whose aunt had systemic lupus erythematosus has three risk factors: gender, age, and family history. The other individuals have only one or two risk factors.

An older adult client with new-onset atrial fibrillation is sweating excessively. After reviewing the client's recent laboratory results, the nurse concludes that which migh be causing the client's symptoms? A) Hgb level of 11.0 g/dL B) TSH level of 0.25 mU/mL C) A TSH level of 18 mU/mL D) Hgb level of 13.8 g/dL

C) TSH level of 18 mU/mL Rationale: New-onset atrial fibrillation and excessive sweating are potential symptoms of hyperthyroidism. A TSH level above 5.5 mU/mL is considered high. TSH 0.25 mU/mL is indicative of hypothyroidism. Hgb 13.8 g/dL and Hgb 11.0 g/dL are both normal hemoglobin levels.

Which treatment should the nurse anticipate for a client who is newly diagnosed with hypothyroidism? A) Radiation B) Partial thyroidectomy C) Treatment with synthetic hormone D) NSAID medications

C) Treatment with synthetic hormone Rationale: The expected treatment for hypothyroidism is replacement with synthetic thyroid hormone. Surgical​ management, such as partial​ thyroidectomy, is used for management of hyperthyroidism. Radiation may also be used in the treatment plan for a client with hyperthyroidism. Nonsteroidal​ anti-inflammatory medications may be used in the management of a client with thyroiditis.

What causes edema in adults with hypothyroidism? A) Excess reabsorption of water and sodium in the kidneys B) Decreased plasma oncotic pressure in the capillaries C) Water retention in mucoprotein deposits in the interstitial spaces D) Increased capillary permeability in the extremities

C) Water retention in mucoprotein deposits in the interstitial spaces Rationale: The hypothyroid state in adults is sometimes called myxedema, which reflects the accumulation of nonpitting edema in connective tissues throughout the body. The edema is the result of water retention in mucoprotein deposits in the interstitial spaces. This redistribution of water may trigger increased reabsorption of water and sodium in the kidneys, but excess reabsorption is not the cause of the edema. Decreased plasma oncotic pressure and increased capillary permeability are less common causes of edema and are usually due to other etiologies

Which physical assessment is most appropriate to include when identifying thyroid problems? SATA A) Medication history B) Percussion C) Palpation D) Observation E) Auscultation

C, D -Palpation -Observation Rationale: Observation,​ palpation, and taking a family history are useful ways of identifying thyroid health problems. Palpation is used to determine the​ location, size, and nodules of the thyroid. Auscultation and percussion are not appropriate methods for this assessment. A medication history would be assessed in the health​ history, not the physical assessment.

The nurse suspects that a client is experiencing hypothyroidism. Which question should the nurse ask during the health history? A) "Is your skin often clammy?" B) "Do you have brown, shiny patches on your legs?" C) "Are you intolerant to heat?" D) "Have you had unexplained weight gain?"

D) "Have you had unexplained weight gain?" Rationale: The client experiencing hypothyroidism often gains weight even though they are eating less. Heat intolerance is associated with hyperthyroidism. Cool, clammy skin is found in clients with low blood sugar. Brown, shiny patches on the lower extremities are associated with poor circulation.

A client reports hoarseness and feelings of tightness in the throat. During the examination, the nurse notes visible swelling at the base of the neck, neck vein distention, a rapid pulse, and sweating. The nurse should suspect which condition in this client? A) Exophthalmos B) Toxic multi-nodular goiter C) Pretibial myxedema d) Graves disease

D) Graves disease Rationale: Graves disease involves an enlargement of the thyroid gland due to overproduction of thyroid hormones.​ Therefore, the nurse would note swelling and neck vein distention. Exophthalmos would be evident by protruding eyeballs. Pretibial myxedema is nonpitting edema and would be noted in hypothyroidism. Toxic multinodular goiter is characterized by small nodules on the thyroid.

An adult client reports a weight gain and feeling cold all the time. Which condition should the nurse suspect? A) Chronic renal failure B) Hyperthyroidism C) Depression D) Hypothyroidism

D) Hypothyroidism Rationale: Weight gain and feeling cold can be symptoms of hypothyroidism. The nurse would conduct an assessment to validate this assumption. Depression would not usually include weight gain or feeling cold. The weight gain of renal failure is usually associated with fluid retention. Hyperthyroidism presents with weight loss and increased sweating.