Thyroid/Parathyroid

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply. A. Hydrocortisone B. Acetaminophen C. Salicylates D. Methimazole E. Iodine

A. Hydrocortisone B. Acetaminophen D. Methimazole E. Iodine Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.

A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? A. Renal failure B. Thyroidectomy C. Decreased serum calcium level D. Steroid use

A. Renal failure Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.

Because there is no one cause for Graves disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves disease? A. constipation B. increased appetite C. blurred vision D. fine hand tremors

A. constipation Clients with Graves disease commonly experience diarrhea, increased appetite, weight loss, visual changes such as blurred or double vision, and fine tremors of the hands, causing unusual clumsiness.

A nurse understands that for the parathyroid hormone to exert its effect, what must be present? A. Decreased phosphate level B. Adequate vitamin D level C. Functioning thyroid gland D. Increased calcium level

B. Adequate vitamin D level Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's 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 client's temperature E. Administering corticosteroids

B. Administering beta blockers to reduce heart rate D. Applying interventions to reduce the client's temperature 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.

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? A. Shield your throat area when near others. B. Flush the toilet several times after every use. C. Prepare food separately from family members. D. Use disposable utensils for the next month.

B. Flush the toilet several times after every use. Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet several times after each use will avoid the exposure of others to radioactive exposure. Shielding the throat area is not effective because this form of treatment is systemic. Preparing food separately is not necessary, but use of separate eating utensils will be necessary for the first 8 days.

An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder? A. Diabetes mellitus B. Diabetes insipidus C. Hypoparathyroidism D. Hyperparathyroidism

D. Hyperparathyroidism Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria.

A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones? A. Propranolol B. Dexamethasone C. Potassium Iodide D. Methimazole

D. Methimazole Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.

When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? A. Angina B. Depression C. Mental confusion D. Hypoglycemia

A. Angina Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines.

The nurse visits the home of a client recovering from a thyroidectomy. Which finding(s) indicates to the nurse that the client is developing hypocalcemia? Select all that apply. A. Hypoactive bowel sounds B. New onset of dysphagia C. Report of stiff hands and feet D. Numbness and tingling of the hands E. +3 pitting edema of the lower extremities

B. New onset of dysphagia C. Report of stiff hands and feet D. Numbness and tingling of the hands During thyroid removal surgery, the risk of removing the parathyroid glands is great. When these glands are removed, hypoparathyroidism occurs which leads to the development of hypocalcemia. Clinical manifestations of hypocalcemia include dysphagia, stiffness of the hands and feet, and numbness and tingling of the hands. Hypoactive bowel sounds and pitting edema are not manifestations of hypocalcemia.

The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to A. discontinue all antithyroid medications. B. monitor for symptoms of hypothyroidism. C. watch for symptoms of hyperthyroidism to disappear within 1 week. D. continue radioactive precautions with all body secretions.

B. monitor for symptoms of hypothyroidism. Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).

A nurse should expect a client with hypothyroidism to report: A. increased appetite and weight loss. B. puffiness of the face and hands. C. nervousness and tremors. D. thyroid gland swelling.

B. puffiness of the face and hands. 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 nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? A. Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. B. Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. C. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. D. Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips.

C. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.

A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis? A. Bradycardia B. Hoarseness C. Hyperthermia D. Tetany

C. Hyperthermia Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106oF (41Co). The pulse is rapid and cardiac dysrhythmias are common. The client may experience persistent vomiting, extreme restlessness with delirium, chest pain, and dyspnea. Hoarseness may be noted due to trauma to the vocal cords during surgery. Tetany indicating hypocalcemia would be manifested if the parathyroid glands are accidentally removed.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? A. Weight loss, increased appetite, and hyperdefecation B. Weight loss, increased urination, and increased thirst C. Weight gain, decreased appetite, and constipation D. Weight gain, increased urination, and purplish-red striae

C. Weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

When caring for a client who's being treated for hyperthyroidism, the nurse should: A. provide extra blankets and clothing to keep the client warm. B. monitor the client for signs of restlessness, sweating, and excessive weight C. loss during thyroid replacement therapy. D. balance the client's periods of activity and rest. E. encourage the client to be active to prevent constipation.

D. balance the client's periods of activity and rest. A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.