Thyroid diseases
Which of the following foods below should a patient experiencing a thyroid storm avoid? Select all that apply: A. Shrimp B. Milk C. Hard boiled eggs D. Seaweed (Kelp) E. Broccoli F. Peas
A, B, C, D - Foods high in iodine are seafoods like shrimp, seaweed, and dairy/eggs.
Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. A. Weight loss B. Protrusion of the eyeballs C. Thick, cold, and dry skin D. Elevated BP E. Purplish-red marks on the abdomen
A, B, D Rationale - Thick, cold, and dry skin are symptoms of hypothyroidism. - Purplish-red marks on the abdomen are seen in Cushing syndrome.
A patient with hypothyroidism is having pain 6 on 1-10 scale in the right hip due to recent hip surgery. Which of the following medications are NOT appropriate for this patient? Select all that apply: A. Fentanyl B. Tylenol C. Morphine D. Dilaudid
A, C, and D. - Patients who have hypothyroidism are very sensitive to narcotics and should take NON-NARCOTICS for pain relief. Fentanyl, Morphine, and Dilaudid are all narcotics, whereas, Tylenol is not.
After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? a) hoarseness of voice b) difficulty in swallowing c) tetany d) fever
a - Hoarseness of voiceLaryngeal nerve damage is manifested by severe hoarseness of voice of "whispery voice".
Why beta-blockers are used in treating hyperthyroidism?
- To slow the heart rate - To relief symptoms of thyrotoxicosis
What are first line drugs that used to treat hyperthyroidism? Select all that apply 1. PTU 2. Methimazole 3. Iodine SSKI 4. Beta-blocker 5. Levothyroxine
1, 2
A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? A. Tapazole B. PTU (Propylthiouracil) C. Synthroid D. Inderal
C - Synthroid is the only medication listed that treats hypothyroidism. All the other medications are used for hyperthyroidism.
You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based on this assessment, you feel that the most likely diagnosis is which of the following? 1. Diabetes insipidus 2. Hypothyroidism 3. Thyroid storm 4. Diabetic ketoacidosis 5. Hyperthyroidism
2
You are the nurse taking care of a 23-year old patient who complains of anxiety, diaphoresis, palpitations, diarrhea, weight loss, and tremors. When examining them you notice exophthalmos and eyelid lag. The most likely diagnosis in your patient is which of the following? 1. Diabetes insipidus 2. Graves' disease 3. Hypothyroidism 4. Glucagonoma 5. Diabetes mellitus
2 - Graves' Disease is an autoimmune condition in which the patient produces autoantibodies to the thyrotropin receptor, which overstimulates the release of T4 and T3, resulting in hyperthyroidism and its associated clinical manifestations (anxiety, palpitations, weight loss, diaphoresis, diarrhea, tremors, etc...). - Further, in Graves' Disease, patients may have exophthalmos and/or lid lag, which are findings that are more specific to Graves' Disease than other causes of hyperthyroidism. This patient's constellation of symptoms is highly consistent with Graves' Disease.
Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? A. Heart rate of 120, blood pressure 220/102, temperature 103.2 'F B. Heart rate of 35, blood pressure 60/43, temperature 95.3 'F C. Soft hair, irritable, diarrhea D. Constipation, drowsiness, goiter
A - A patient is at risk for experiencing thyroid storm after a thyroidectomy because of manipulation of the thyroid gland that could cause excessive T3 and T4 to enter into the bloodstream during removal of the gland. Therefore, heart rate of 120, blood pressure 220/102, temperature 103.2 'F are classic signs of thyroid storm and this requires nursing intervention.
Which of the following lifestyle exposures can lead to a thyroid disorder? 1. Asbestos 2. Nonsteroidal anti-inflammatory drugs (NSAIDs) 3. Diet high in oxalates 4. Smoking
4 - Smokers have higher levels of the chemical thiocyanate, a degradation product of cyanide in tobacco smoke, which can block iodine uptake by the thyroid
A patient is receiving radioactive iodine treatment for hyperthyroidism. What will you include in your patient education to this patient about this type of treatment? A. Taste changes and swollen salivary glands B. Constipation C. Excessive thirst D. Sun protection
A
A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels
A
Which of the following side effects are possible for a patient taking an anti-thyroid medication? A. Agranulocytosis and aplastic anemia B. Tachycardia C. Skin discoloration D. Joint pain and eczema
A
To promote optimal absorption, the nurse would instruct a patient to take their levothyroxine at which time? A. 0600 B. 1200 C. 1600 D, 2100
A Rationale - For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast. - 1200, 1600, and 2100 may not result in adequate absorption.
A patient who is in her first trimester of pregnancy is diagnosed with hyperthyroidism. Which medication do you suspect the patient will be started on? A. Propylthiouracil (PTU) B. Radioactive Iodine C. Tapazole D. Synthroid
A - Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st trimester of pregnancy.
You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."
A - Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid.
For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? a. Hypocalcemia b. Hypercalcemia c. Hypokalemia d. Hyperkalemia
A - The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes).
A patient taking Tapazole reports feeling dizzy, intolerant to cold, and tired. On assessment, you note the patient's heart rate is 45 and blood pressure is 70/30. What is the most likely cause? A. Antithyroid toxicity B. Agranulocytosis C. Thyroid storm D. Bronchospasm
A - The patient may be experiencing antithyroid toxicity (too much of the antithyroid medication). This will causes signs and symptoms of hypothyroidism which can lead to a myxedema coma, if not treated immediately.
A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT? A. "I will continue taking aspirin daily." B. "I will take this medication at the same time every day." C. "It may take a while before I notice that the medication is helping my condition." D. "I will avoid foods containing high levels of iodine."
A - The patient needs to be instructed NOT to take aspirin because it increases thyroid hormones. All the other statements are correct.
A patient is admitted with thyroid storm. Which sign and symptoms are NOT present with this condition-SELECT ALL THAT APPLY? A. Temperature of 104.9'F B. Heart rate of 125 bpm C. Respirations of 42 D. Heart rate of 20 bpm E. Intolerance to cold F. Restless
D, E
Fill in the blank regarding the negative feedback loop for thyroid hormone production: The ______________ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce _______________ which in turn causes the thyroid gland to release _______ and _______.* A. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 B. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 C. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 D. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid-stimulating hormone), T3 and TSH
B
What is the most common cause of hyperthyroidism? A. Hashimoto's thyroiditis B. Graves' disease C. Thyroid storm D. Toxic nodular goiter
B
Which symptom would the nurse expect to see in a patient suspected of having hypothyroidism? A. Diaphoresis B. Constipation C. Heat intolerance D. Systolic hypertension
B Rationale - Diaphoresis, heat intolerance, and systolic hypertension are symptoms of hyperthyroidism. - Hypothyroidism causes cold intolerance, not heat intolerance. - Other symptoms of hypothyroidism include lethargy, weakness, muscle aches, weight gain, dry skin and hair, loss of body hair, and bradycardia.
Which of the following medication orders should a nurse question if ordered on a patient with thyroid storm? A. Propylthiouracil "PTU" for a 25-year-old who is 8 weeks pregnant B. Aspirin as needed for a fever greater than 102.2 'F C. Inderal for a patient who reports having insomnia D. Tapazole for a 30-year-old having complaint of a headache
B - A patient who has hyperthyroidism or thyroid storm should NEVER take salicylate (ex: aspirin) because it canincrease thyroid hormones. All the other options are correct or insignificant for why the patient is taking the medication.
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing? A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter
B - Myxedema Coma...The red flags in this question are the patient's signs/symptoms and the report from the family the patient hasn't been taking the prescribed Synthroid. The patient is showing signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not treated).
A physician orders a patient in thyroid storm to be started on Inderal. What in the patient's health history causes the nurse to question the doctor's order? A. History of mental illness B. History of asthma C. History of tachycardia D. History of cancer
B - Patients with a history of asthma should not take Inderal (a beta blocker) because it can cause asthma exacerbation or bronchospasm. Therefore, the nurse should question this order.
Which of the following are not a treatment for Thyroid Storm? A. Propylthiouracil (PTU) B. Synthroid C. Inderal D. Glucocorticoids
B - Synthroid is a medication treatment for HYPOthyroidism. All the other options are for HYPERthyroidism.
Which patient is most at risk for Thyroid Storm? A. A 60 year old female who reports not taking Synthroid regularly. B. A 45 year old male who has not been taking Tapazole as ordered and is experiencing diabetic ketoacidosis. C. A 6 year old with an allergy to iodine. D. A 25 year old female who is pregnant with her 4th child and is experiencing eczema.
B - The red flag in this option is "not been taking Tapazole" and is experiencing "DKA". This indicates the patient has hyperthyroidism (Tapazole is an antithyroid medication) and this already puts him at risk for thyroid storm. Then DKA is another added stress on the body that can send him into thyroid storm. All the other options are either incorrect or the patient is at risk for myxedema coma (a complication of HYPOTHYROIDISM).
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 usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Select all that apply A. Storing calories B. Increasing the Heart Rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland
B, C, E - T3 and T4 burn calories (not store them) and increases body temperature (not decrease).
Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. A. Enlarged, scaly tongue B. A positive bruit upon auscultation of the thyroid gland C. Dry, thick, inelastic, and cold skin D. A goiter E. Clubbing of the fingers
B, D, E Rationale - Enlarged, scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.
Which laboratory results would confirm overt hyperthyroidism? Select all that apply. A. Elevated thyroid-stimulating hormone (TSH) level B. Elevated triiodothyronine (T3) level C. Low free thyroxine (T4) level D. Elevated free T4 level E. Low TSH level
B, D, E Rationale - The primary laboratory findings to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels and elevated free thyroxine levels and T3 levels. - Low free T4 levels and elevated TSH levels are found with hypothyroidism.
___________ is an autoimmune disorder where the body attacks the thyroid gland that causes it to stop releasing T3 and T4. The patient is likely to have the typical signs/symptoms of hypothyroidism, however, they may present with what other sign as well? A. Myxedema coma; joint pain B. Thyroid storm; memory loss C. Hashimoto's Thyroiditis; goiter D. Toxic nodular goiter (TNG); goiter
C - Hashimoto's Thyroiditis; goiter
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? A. Thyroiditis B. Deficiency of iodine consumption C. Grave's Disease D. Hypothyroidism
C
Lugol's solution helps block ________ of thyroid hormones in thyroid storm. Which of the following are a common side effect of this medication? A. the removal; tophi B. excretion; swollen lymph nodes C. release/ synthesis; taste changes D. movement; hypocalcemia
C
Which clinical manifestation is a classic finding in Graves' disease? A. Gingivitis B. Cretinism C. Exophthalmos D. Muscular dystrophy
C
In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs
C - Weight loss, anxiety, insomnia and palpitations are signs of hyperthyroidism. An adjustment in dose would need to be obtained in order to reach a therapeutic level of levothyroxine (Synthroid) in the patient with hypothyroidism.
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Smooth skin D. Hair loss
D
A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for: A) gingival hyperplasia and lycopenemia. B) dyspnea and a dry cough. C) blurred vision and nystagmus. D) fever and sore throat.
D
Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
D - In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. - Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
What drug replace PTU after 1st trimester in treating hyperthyroidism?
Methimazole
What anti-thyroid drug that is used for pregnant women that are in 1st trimester?
PTU
Why the 1st dose of levothyroxine is given in low dosage?
To avoid increasing in resting HR and BP
The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply a) instill isotonic eye drops as necessary b) provide several, small, well-balanced meals c) provide rest periods d) keep environment warm e) encourage frequent visitors and conversation f) weigh the client daily
a, b, c, f (a) The client with hyperthyroidism may experience exophthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea. (b and f) The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. (c) The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.
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 - Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? a. Dysuria b. Leg cramps c. Tachycardia d. Blurred vision
c - Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia.