Thyroid Disease

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

"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

The nurse is caring for a client newly diagnosed with Graves disease. The client asks the nurse how the goiter occurred. Which factor should the nurse include in the​ response? (Select all that​ apply.) A. The thyroid cells become hypoactive. B. Antibodies bind to the​ thyroid-stimulating hormones. C. The​ client's tissues form antibodies. D. The thyroid gland enlarges. E. The​ client's tissues form antigens.

Antibodies bind to the​ thyroid-stimulating hormones. The​ client's tissues form antibodies. The thyroid gland enlarges. 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.

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​ 60-year-old African American man B. A​ 40-year-old woman with a goiter C. A​ 50-year-old man with hypothyroidism D. A​ 10-year-old child with congenital hypothyroidism

A​ 40-year-old 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

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. Toxic multinodular goiter B. Graves disease C. Pretibial myxedema D. Exophthalmos

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.

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

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 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? (Select all that​ apply.) A. Bradycardia B. Premature fontanelle closure C. Heart failure D. Nonpalpable thyroid gland E. Respiratory difficulties

Premature fontanelle closure Heart failure Respiratory difficulties 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.

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? (Select all that​ apply.) A. Radiation of the neck B. Autoimmune disease C. Radioactive iodine treatment D. Male sex E. Thyroid surgery

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

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 reviews the laboratory results for a client and notes that the T4 level is low. Which prescription should the nurse anticipate the healthcare provider to​ prescribe? A. Radioactive iodine B. Thyroid replacement C. Beta blocker D. Antithyroid medications

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.

Which physical assessment parameter is most appropriate for the nurse to include when assessing the client for possible​ hyperthyroidism? (Select all that​ apply.) A. Deep tendon reflexes B. Vision test C. Weight loss D. Vital signs E. Confusion

​Deep tendon reflexes Vision test Weight loss Vital signs 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

The nurse is preparing a client with hyperthyroidism for radioactive iodine treatments. Which information should the nurse provide to the client prior to this​ procedure? (Select all that​ apply.) A. How to measure the radial pulse B. That hospitalization is usually required C. That the end results are immediately seen D. That the client may need lifelong thyroid replacement E. That radioactive iodine is given intravenously

​How to measure the radial pulse That the client may need lifelong thyroid replacement 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.

Which manifestation should the nurse monitor when caring for a client on thyroid hormone​ (TH) replacement​ therapy? (Select all that​ apply.) A. Improvement of symptoms of hypothyroidism B. Decrease in appetite C. Stable vital signs D. Report of dizziness E. Symptoms of hyperthyroidism

​Improvement of symptoms of hypothyroidism Stable vital signs Report of dizziness Symptoms of hyperthyroidism 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.

Which physical assessment is most appropriate to include when identifying thyroid​ problems? (Select all that​ apply.) A. Observation B. Auscultation C. Percussion D. Medication history E. Palpation

​Observation Palpation 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.

Which priority should the nurse include in the teaching plan for a client with Graves​ disease? (Select all that​ apply.) A. Tape your eyelids closed at night. B. Take antithyroid drugs as prescribed. C. Drink six to eight glasses of water a day. D. Eat a​ low-calorie diet. E. Weigh yourself daily.

​Tape your eyelids closed at night. Take antithyroid drugs as prescribed. Drink six to eight glasses of water a day. Weigh yourself daily. 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.

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

​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.

Which treatment should the nurse anticipate for a client who is newly diagnosed with​ hypothyroidism? A. Nonsteroidal​ anti-inflammatory medications B. Radiation C. Partial thyroidectomy D. Treatment with synthetic hormone

​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.

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. Hyperemesis gravidarum B. Type 2 diabetes mellitus C. History of toxic multinodular goiter D. Uncontrolled hypothyroidism

​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.

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

​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.

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

​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.

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

​​"A thyroidectomy may be performed if the thyroid is placing pressure on the​ esophagus." ​"A thyroidectomy may be performed if the thyroid is compromising the​ airway." ​"A total thyroidectomy is performed to treat cancer of the​ thyroid." 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.