EAQ Med-Surg Chapter 63 (Thryroid)
Which assessment finding does the nurse associate with Graves' disease? - Increased sweating - Intolerance to heat - Dyspnea with or without exertion - Abnormal protrusion of the eyes
- Abnormal protrusion of the eyes Exophthalmos, or abnormal protrusion of the eyes, is specific sweating or diaphoresis because of heat intolerance. Dyspnea with or without exertion is also common in patients with hyperthyroidism.
Which are common symptoms of hypothyroidism? SATA - Anorexia - Hot flashes - Hypertension - Hyperventilation - Impaired memory - Poor wound healing
- Anorexia - Impaired memory - Poor wound healing Common symptoms of hypothyroidism include anorexia, impaired memory, and poor wound healing. Individuals with hypothyroidism often experience a decreased body temperature and cold intolerance, not hot flashes. Individuals with hypothyroidism generally present with hypotension and hypoventilation.
A patient is being discharged with propylthiouracil (PTU). Which statement by the patient indicates a need for further teaching by the nurse? - "I must call if my urine is dark." - "I need to report weight gain." - "I can return to my job at the nursing home." - "I must faithfully take the drug every 8 hours."
- "I can return to my job at the nursing home." The patient should avoid large crowds and people who are ill because propylthiouracil (PTU) reduces blood cell counts and the immune response, which increases the risk for infection. The patient does not need to remain completely at home. Dark urine may indicate liver toxicity or failure and the patient must notify the provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures better drug action. The patient must notify the provider of weight gain because this may indicate hypothyroidism; a lower drug dose may be required.
The nurse is evaluating how well a patient understands the hormonal replacement therapy that has been prescribed for the management hypothyroidism. Which patient statement indicated a need for further teaching? - "I should get my thyroid levels checked regularly." - "I should consume more fluids and foods rich in fiber." - "I can stop taking my medications when I feel better." - "I should not take any over-the-counter medications without checking with my health care provider first."
- "I can stop taking my medications when I feel better." A patient with hypothyroidism will need to take hormonal therapy for the rest of his or her life, not just until they feel better. The other statements indicate understanding. The patient must have thyroid levels checked regularly to avoid complications such as hyperthyroidism. The patient should consume more fluids and fiber-rich foods to avoid constipation. Taking OTC medications along with hormonal therapy may have unnecessary adverse effects.
The nurse is teaching a patient about thyroid replacement therapy. Which statement by the patient indicates a need for further teaching? - "I should take it every morning." - "I should have more energy with this medication." - "If I continue to lose weight, I may need an increased does." - "If I gain weight and feel tired, I may need an increased dose."
- "If I continue to lose weight, I may need an increased does." Weight loss indicates a need for a decreased dose, not an increased dose. One of the symptoms of hypothyroidism is lack of energy; thyroid replacement therapy should help the patient have more energy. If the patient is gaining weight and continues to feel tired, that is an indication that the dose may need to be increased.
Family members of a patient diagnosed with hyperthyroidism voice concern regarding the patient's frequent mood swings. How should the nurse respond to family members? - "How does that make you feel?" - "The mood swings should diminish with treatment." - "Your family member is sick. You must be patient." - "The medications will make the mood swings disappear completely."
- "The mood swings should diminish with treatment." Telling the family that the patient's mood swings should diminish over time with treatment will provide information to the family, as well as reassurance. Asking how the family feels is important; however, the response should focus on the patient. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware the the patient is sick; telling them to be patient introduces guilt and does not address the family's concerns.
A patient is taking methimazole for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? - "You should see effects of this medication immediately." - "You should see effects of this medication within 1 week." - "You should see full effects from this medication within 1-2 days." - "You should see some effects of this medication within 2 weeks."
- "You should see some effects of this medication within 2 weeks." Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The patient should see some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal. Although onset of action is 30-40 minutes after an oral dose, the patient will not see effects immediately. Effects will take longer than 1 week to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of T3 and T4 will be monitored and dosages adjusted as levels fall.
A patient has been prescribed radioactive iodine (RAI) therapy for hyperthyroidism. What does the nurse teach the patient about this therapy? - "You will receive RAI in the form of oral 131I." - " This treatment is done on an inpatient basis." - "The radiation dose will be eliminated within a week." - "You will have complete relief from symptoms in 1 week."
- "You will receive RAI in the form of oral 131I." RAI is provided in the form of oral 131I. The dosage depends on the size of the thyroid gland and its sensitivity to radiation. Some of the cells that produce thyroid hormones to an extent. Therefore, the patient may not have complete relief of symptoms until 6 to 8 weeks after RAI therapy. Radioactivity is present in the patient's body fluids and stool for a few weeks even after the therapy is complete. The patient must take radiation precautions to prevent exposure to family members and other people. RAI treatment is done on an outpatient basis; most patients require only one sitting, whereas some may require two or three sittings.
A patient is diagnosed with hypoparathyroidism. which prescribed intervention will treat symptoms that include severe muscle cramps, spasms of the feet and hands, and seizures? - 0.5 to 2 mg of oral calcitriol daily - 50,000 units of oral ergocalciferol daily - 10% solution of IV calcium chloride for 10 to 15 minutes - 50% solution of IV magnesium sulfate in 2 mL doses, up to 4 g daily
- 10% solution of IV calcium chloride for 10 to 15 minutes Severe muscle cramps, spasms of the feet and hands, and seizures are caused by severe hypocalcemia resulting from hypoparathyroidism. A 10% solution of IV calcium chloride can treat the hypocalcemia. Administration of 0.5 to 2 mg of oral calcitriol helps manage acute vitamin D deficiency. Oral ergocalciferol is used in the long-term management of vitamin D deficiency. IV magnesium sulfate is used in the management of hypomagnesemia in a patient with hypoparathyroidism.
The nurse is caring for four patients with different health conditions. Which patient is most likely to develop psychotic behavior? - 33 y/o female receiving treatment for thyroid storm - 60 y/o male recovering from hip replacement - 53 y/o female receiving radiation therapy for breast cancer - 48 y/o being treated with IV antibiotics for cellulitis
- 33 y/o female receiving treatment for thyroid storm The nurse should monitor the patient who is receiving treatment for a thyroid storm for the presence and development of psychotic behavior. This patient will often present with anxiety and tremors which can progress to restlessness, confusion, psychosis, and seizure activity. A patient who is postoperative for a hip replacement is at risk for delirium, but not at high risk for psychosis. A patient who is receiving radiation therapy for breast cancer and a patient receiving treatment for cellulitis with IV antibiotics are not at high risk for psychosis.
A patient who underwent a thyroid scan tested positive for multiple thyroid nodules. What percentage of radioactive iodine uptake (RAIU) by thyroid gland does the nurse anticipate? - 5% - 15% - 30% - 50%
- 50% The normal thyroid gland has an uptake of 5% to 35% of the given does at 24 hours. RAIU is increased in hyperthyroidism and can be used to identify active thyroid nodules. The other choices are considered normal.
A patient being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? - Advise the patient to go to a calming environment - Ask whether the patient has increased cold sensitivity or weight gain - Instruct the patient to see his health care provider immediately - Tell the patient to check his pulse again and call back later
- Ask whether the patient has increased cold sensitivity or weight gain Increased sensitivity to cold and weight gain are symptoms of hypothyroidism, indicating an overcorrection of the medication. The patient must be assessed further because he may require a lower does of medication. A calming environment will not have any effect on the patient's heart rate. The patient will want to notify the health care provider about the change in heart rate. If other symptoms such as chest pain, SoB, or confusion accompany the slower heart rate, then the patient should see the health care provider immediately. If the patient was concerned enough to call because his heart rate was slower than usual, the nurse needs to stay on the phone with the patient while he rechecks his pulse. This time could also be spent providing education about normal ranges for that patient.
The nurse reviews the vital signs of a patient diagnosed with Graves' disease. The patient's temperature is up to 99.6°F. After notifying the health care provider, what does the nurse do next? - Asks any visitors to leave - Administers acetaminophen - Alerts the Rapid Response Team - Assesses the patient's cardiac status completely
- Assesses the patient's cardiac status completely If the patient's temperature has increased by even one degree, the nurse's first action is to notify the provider. Continuous cardiac monitoring should be the next step. Administering acetaminophen is appropriate, but is not a priority action for this patient. Alerting the Rapid Response Team is not needed at this time. Asking visitors to leave would not be the next action, and if visitors are providing comfort to the patient, this would be contraindicated.
A patient diagnosed with hypothyroidism has been prescribed hormone replacement therapy. What does the nurse teach the patient about this therapy? - Include fiber supplements in the diet - Take the prescribed therapy before bedtime - Avoid taking OTC drugs - Monitor urine frequency for therapy effectiveness
- Avoid taking OTC drugs The patient with hypothyroidism taking hormone replacement therapy should avoid OTC drugs because thyroid hormone preparations interact with many other drugs. The patient must assess sleep and bowel patterns for therapy effectiveness. If a patient requires more sleep and is constipated, the dosage may need to be increased.
Which causes of hypothyroidism result from a decrease in thyroid tissue? SATA - Endemic iodine deficiency - Congenital pituitary defects - Cancer (thyroidal or metastatic) - Autoimmune thyroid destruction - Congenital poor thyroid development - Pituitary tumors, trauma, infections, or infarcts
- Cancer (thyroidal or metastatic) - Autoimmune thyroid destruction - Congenital poor thyroid development Hypothyroidism related to a decrease in thyroid tissue may result from cancer (thyroidal or metastatic), autoimmune thyroid destruction, or congenital poor thyroid development. Endemic iodine deficiency results in decreased synthesis of thyroid hormone. Congenital pituitary defects and pituitary tumors, trauma, infections, or infarcts result in inadequate production of thyroid-stimulating hormone.
Which problems commonly occur with myxedema? SATA - Coma - Hypertension - Hypothermia - Hypoglycemia - Hypernatremia - Respiratory failure
- Coma - Hypothermia - Hypoglycemia - Respiratory failure Common problems that occur with myxedema include coma, hypothermia, hypoglycemia, hypotension, hyponatremia, and respiratory failure.
What assessment finding indicates a possibility of hyperthyroidism in a patient? - Intolerance to cold - Decreased appetite - Heart rate of 54 beats/min - Considerable loss of weight without dieting
- Considerable loss of weight without dieting A patient who is not on a diet but has lost considerable weight is a likely candidate for hyperthyroidism. Although hyperthyroidism can cause increased appetite, there is considerable weight loss and an increase in the number of bowel movements per day. The patient with hyperthyroidism is intolerant to heat, not cold, and has diaphoresis. Bradycardia is indicative of hypothyroidism; an elevated heart rate is a sign of hyperthyroidism.
Which physiological effect does the nurse expect to find in a patient with thyroiditis? - Dysphagia - Weight gain - Heat intolerance - Cold intolerance
- Dysphagia Thyroiditis is inflammation of the thyroid gland caused by a bacterial or viral infection. Its physiological effects include dysphagia, pain, neck tenderness, and fever. Weight gain is seen in patients with hypothyroidism as a result of decreased metabolism. Heat intolerance is characteristic of hyperthyroidism. Cold intolerance is a manifestation of hypothyroidism.
A patient admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. Based on the patient's symptoms, what should the nurse do? - Call the provider - Tell the patient to slow down - Encourage the patient to rest - Immediately assess cardiac status
- Encourage the patient to rest The patient with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse should accept the patient's behavior and provide a calm, quiet, and comfortable environment. Because the patient's behavior is expected, there is no need to call the provider. Monitoring the patient's cardiac status is part of the nurse's routine assessment. Telling the patient to slow down is unsupportive and unrealistic.
Which autoimmune disorder may be triggered by a bacterial or viral infection? - Graves' disease - Thyroid cancer - Myxedema coma - Hashimoto's disease
- Hashimoto's disease Chronic thyroiditis, also known as Hashimoto's disease, is an autoimmune disorder that may be triggered by a bacterial or viral infection. Graves' disease is also an autoimmune disorder that results in hyperthyroidism. Thyroid cancer may be congenital or may be caused by various factors such as infections or surgical injury. Myxedema coma is a complication of untreated hypothyroidism; it is not an autoimmune disorder.
While assessing a patient with an endocrine disorder, the nurse hears an audible bruit over the thyroid gland. The presence of a mass or cyst is noted on the patient's ultrasound report. The primary health care provider prescribes radioactive iodine. What condition might the patient be experiencing? - Hypothyroidism - Hyperthyroidism - Hypoparathyroidism - Hyperparathyroidism
- Hyperthyroidism An audible bruit over the thyroid gland because of increased blood flow is an indication of hyperthyroidism. A mass or cyst indicates an enlarged thyroid gland, which may be a goiter. The primary health care provider prescribes radioactive iodine therapy to ablate the enlarged thyroid gland. Hypothyroidism is characterized by weight gain and impaired cardiac and respiratory functions and is treated with levothyroxine, which is a thyroid hormone supplement. Hypoparathyroidism is characterized by excessive or inappropriate muscle contractions and is treated with parathormone. Hyperparathyroidism is characterized by weight loss, and increased risk of facture, and renal calculi. It is treated with calcitonin.
A nurse is assessing a patient with a goiter due to hypothyroidism. What factor causes a goiter in this patient? - Presence of nodules or benign tumors - Presence of thyroid-stimulating immunoglobulins (TSI) - Increase in the number and size of thyroid glandular cells - Increase in the production of thyroid-stimulating hormones (TSH)
- Increase in the production of thyroid-stimulating hormones (TSH) The patient with hypothyroidism has low levels of thyroid hormone and a decreased metabolic rate. This causes the hypothalamus and anterior pituitary gland to increase production of TSH. TSH binds to the thyroid cells and forms a goiter. Nodules and benign tumors can cause toxic multinodular goiter due to hyperthyroidism. In Graves' disease, TSI attaches to TSH receptors on the thyroid issue. The thyroid gland responds by increasing the number and size of glandular cells. This enlarges the thyroid gland, forming a goiter.
What does the nurse expect to find when assessing a patient with hyperthyroidism? - Weight gain - Increased appetite - Increased body fat - Decreased blood glucose
- Increased appetite The patient with hyperthyroidism reports an increase in appetite. Hyperthyroidism causes increased metabolism; as a result, fat metabolism is increased. This leads to weight loss and a reduction in body fat. The patient with hyperthyroidism has decreased glucose tolerance, leading to hyperglycemia or increased blood glucose.
A patient with hypothyroidism is being discharged. Which environment change may need to be made in the patient's home. - Frequent home care - Handrails in the bath - Increased thermostat setting - Strict infection-control measures
- Increased thermostat setting Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary. A patient with a diagnosis of hypothyroidism can be safely managed at home with adequate discharge teaching regarding medications and instructions on when to notify the health care provider or home health nurse. In general, hypothyroidism does not cause mobility issues. Activity intolerance and fatigue may be an issue, however. A patient with hypothyroidism is not immune-compromised or contagious, so no environment changes need to be made to the home.
A patient who is receiving thyroid replacement therapy for hypothyroidism reports constipation and insomnia. What should be included in this patient's plan of care? - Administering sedatives - Increasing fiber in the diet - Increasing the medication dose - Discontinuing thyroid treatment
- Increasing the medication dose A patient with thyroid replacement therapy is required to have a dose adjustment depending on clinical parameters and signs and symptoms. The medication dose should be increased when the patient experiences insomnia and is constipated. An increase of fiber in the diet treats only the constipation, but does not address the insomnia. Sedatives may help treat insomnia, but they do not address the constipation. Discontinuing thyroid therapy would not be helpful to either condition.
Which are symptoms of hyperthyroidism? SATA - Insomnia - Palpitations - Low-grade fever - Slowed respiration - Decreased appetite - Restlessness and irritability
- Insomnia - Palpitations - Low-grade fever - Restlessness and irritability Symptoms of hyperthyroidism include insomnia, palpitations, low-grade fever, and restlessness or irritability. Hyperthyroidism results in rapid, shallow respirations. Appetite is increased in people with untreated hyperthyroidism.
A patient has been diagnosed with hypothyroidism. What medication is routinely prescribed to treat this disorder? - Atenolol - Methimazole - Levothyroxine sodium - Propylthiouracil (PTU)
- Levothyroxine sodium Levothyroxine is a synthetic form of T4 that is used to treat hypothyroidism. Atenolol is a beta blocker that is used to treat cardiovascular disease. Methimazole and propylthiouracil are used to treat hyperthyroidism.
Which safety precaution is appropriate for the patient receiving an unsealed radioactive isotope? - Stand while urinating - Avoid the use of laxatives - Flush the toilet once after use - Maintain at least 3 ft of distance from infants
- Maintain at least 3 ft of distance from infants A patient who receives an unsealed radioactive isotope must avoid close contact with pregnant women, infants, and young children, at least 3 feet from them. The nurse should advise the patient to urinate in a sitting position to avoid splashing the seat, walls, and floor. The patient should use laxatives on the second or third day after receiving the drug; this helps excrete contaminated stool more quickly. The patient must flush the toilet at least three times after each use to let the radioactive substances flush away.
Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II? - Follicular - Papillary - Medullary - Anaplastic
- Medullary Medullary carcinoma commonly occurs as part of MEN type II, which is a familial endocrine disorder. Anaplastic carcinoma is an aggressive tumor that invades surrounding tissue. Follicular carcinoma occurs more frequently in older patients and may metastasize to bone and lung. Papillary carcinoma is the most common type of thyroid cancer. It is slow-growing and if the tumor is confined to the thyroid gland, the outlook for a cure is good with surgical management.
Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a patient who has just arrived after a total thyroidectomy? - Assess the wound dressing for bleeding - Give morphine sulfate 4-8 mg IV for pain - Support the head and neck with sandbags - Monitor oxygen saturation using pulse oximetry
- Monitor oxygen saturation using pulse oximetry Airway assessment and management is always the first priority with every patient. This is especially important for a patient who has had surgery that involves potential bleeding and edema near the trachea. Assessing the wound dressing for bleeding is a high priority, although this is not the first priority. Pain control and supporting the head and neck with sandbags are important priorities, but should be addressed after assessing the patient's airway.
Which nursing intervention is beneficial for a patient with hyperthyroidism? - Checking the patient's body weight daily - Encouraging the patient's body temperature every 4 hours - Monitoring the patient's body temperature every 4 hours - Asking the patient about tingling the mouth, toes, or fingers
- Monitoring the patient's body temperature every 4 hours An increase in body temperature indicates a rapid worsening of the patient's condition and the onset of a thyroid storm, which is a life-threatening condition. As a result, the nurse should monitor the patient's body temperature every 4 hours. Checking body weight daily is beneficial for patients with hypothyroidism because they have rapid weight gain. The nurse asks about tingling around the mouth or in the toes and fingers for patients who have has their parathyroid gland removed because they may experience hypocalcemia and tetany. Using artificial tears is encouraged for the patient with exophthalmos.
The nurse is monitoring a patient who had a thyroidectomy. What manifestation indicates injury to the parathyroid gland? - Weak voice - Hemorrhage - Hoarseness - Muscle twitching
- Muscle twitching Muscle twitching is a sign of calcium deficiency. Injury to the parathyroid gland results in hypocalcemia or low serum calcium levels. Hemorrhage is most likely to occur in the first 24 hours after surgery but is not related to damage to the parathyroids. Hoarseness and weak voice may occur as a result of laryngeal nerve damage during the surgery.
Which assessment finding is considered a grade 1 goiter? - No bruits upon auscultation of the neck - No visible or palpable swallowing movements - Easily palpable and usually asymmetric thyroid enlargement - No visible thyroid enlargement when the neck is in a normal position
- No visible thyroid enlargement when the neck is in a normal position The patient with a grade 1 goiter does not have thyroid enlargement, which normally is visible when the neck is in normal position. However, the mass can be palpated and moves up and down when the patient swallows. When swallowing movements are not visible or felt on palpation, the patient has a grade 0 goiter. This is further confirmed by the absence of bruits when the neck is auscultated. The patient with a grade 2 goiter has a thyroid enlargement that is easily palpable and usually asymmetric.
The condition of a pregnant patient with hyperthyroidism rapidly worsens and leads to thyroid storm. What are the appropriate drugs and their sequence of administration? - Oral administration of Lugol's solution 1 hour after methimazole - Oral administration of Lugol's solution 1 hour after PTU - Simultaneous oral administration of Lugol's solution and methimazole - Simultaneous oral administration of Lugol's solution and PTU
- Oral administration of Lugol's solution 1 hour after PTU In a thyroid storm, iodine-containing drugs (Lugol's solution) are administered 1 hour after the thionamides (methimazole and PTU). Initially, the iodine agents can cause an increase in the production of thyroid hormones. Therefore, administering a thionamide first prevents this initial increase in thyroid hormone production. Methimazole can cause birth defects and should not be used during pregnancy, especially during the first trimester. Simultaneous administration of Lugol's solution and PTU is not effective in preventing the initial increase in thyroid hormone production from the iodine agent.
Which type of thyroid cancer is most common? - Papillary - Follicular - Medullary - Anaplastic
- Papillary Papillary carcinoma is the most common type of thyroid cancer, and it occurs most often in young women. The others occur less frequently.
Which is the most common type of thyroid cancer in younger women? - Papillary carcinoma - Follicular carcinoma - Medullary carcinoma - Anaplastic carcinoma
- Papillary carcinoma Papillary carcinoma is the most common type of thyroid cancer in younger women and is characterized by slowly growing tumors. Follicular carcinoma invades blood vessels and bone, and occurs most commonly in older adults. Medullary carcinoma is the most common thyroid cancer in patients older than 50 years of ago. Anaplastic carcinoma is a rare, rapid-growing, and aggressive tumor.
Which manifestation is a hallmark sign of hyperthyroidism? - Eye fatigue - Weight loss - Increased libido - Poor thermoregulation
- Poor thermoregulation A hallmark sign of hyperthyroidism is poor thermoregulation with hear intolerance. The patient may have increased sweating even when the temperature of the environment is comfortable for others. Eye fatigue, weight loss, and increased libido are also features of hyperthyroidism but are not hallmark signs.
What is the most common cause of hypothyroidism in the United States? - Intake of tyrosine - Consumption of saltwater fish - Reduced intake of iodine - Radioactive iodine treatment
- Radioactive iodine treatment The most common cause of hypothyroidism in the U.S. is radioactive iodine (RAI) treatment and thyroid surgery for hyperthyroidism. Hypothyroidism was common in the Midwest region of the U.S. before iodine was added to table salt and saltwater fish was widely available. Tyrosine and iodine are compounds essential to produce thyroid hormones. Saltwater fish is a good source of iodide and prevents hypothyroidism. Endemic goiter due to hypothyroidism is found in areas where soil and water have little natural iodide.
What intervention is appropriate when caring for a patient during myxedema coma? - Replacing fluids with IV normal saline - Maintaining a reduced room temperature - Monitoring temperature every 2 hours - Monitoring blood pressure every half hour
- Replacing fluids with IV normal saline The patient who is experiencing myxedema coma should receive IV normal or hypertonic saline to replace fluids and correct dehydration. The patient will be intolerant to cold so the room temperature must be moderate. Warm blankets must be used to keep the patient warm. The patient's temperature and blood pressure must be monitored every hour; even a slight increase must be reported to the health care provider.
The nurse assigns an unlicensed assistive personnel (UAP) to monitor the temperature of the patient with Graves' disease. What does the nurse instruct the UAP to do? - Monitor the patient's temperature every 6 hours. - Document the findings and report them at the end of the shift - Report even a 1°F increase in temperature immediately - It is normal for the patient to have an elevated temperature
- Report even a 1°F increase in temperature immediately The nurse should instruct the UAP to report even a 1°F increase in temperature immediately because any increase in temperature may indicate a rapid worsening of the patient's condition and the onset of a thyroid storm. The patient's temperature should be measured at least every 4 hours, documented, and reported to the nurse as soon as it is obtained. The patient with Graves' disease experiences diaphoresis and has heat intolerance, so an elevated temperature must be reported to the nurse immediately.
Which type of thyroiditis does the nurse suspect in a patient who complains of cold, fever, chills, dysphagia, and muscle joint pains? - Acute thyroiditis - Chronis thyroiditis - Subacute thyroiditis - Idiopathic thyroiditis
- Subacute thyroiditis Subacute or granulomatous thyroiditis results from a viral infection of the thyroid gland after a cold or other upper respiratory infection. Manifestations include fever, chills, dysphagia, and muscle and joint pain. Acute thyroiditis is caused by bacterial invasion of the thyroid gland. Manifestations include pain, neck tenderness, malaise, and fever. It resolves with antibacterial therapy. Chronic thyroiditis (Hashimoto's disease) is an autoimmune disorder without any characteristic symptoms. Thyroiditis is never idiopathic in nature.
What does the nurse teach on older patient about the effect aging has on thyroid hormones? SATA - The thyroid gland increases in size - The basal metabolic rate decreases - Thyroid hormone secretion decreases - Body composition changes from muscular to fatty - Higher doses of thyroid replacement hormone will be needed
- The basal metabolic rate decreases - Thyroid hormone secretion decreases - Body composition changes from muscular to fatty Thyroid hormone secretion decreases with age, resulting in slower metabolic rates. The basal metabolic rate decreases as a result of decreased activity. The decrease in activity results in a change in body composition from predominantly muscular to predominantly fatty. The thyroid gland decreases in size with increasing age, thus causing decreased secretion of thyroid hormone. The older patient starts with a lower does of thyroid-replacement hormone; a high dose can adversely affect the heart muscle.
What is follicular carcinoma of the thyroid? - It is a slow-growing tumor - The tumor secretes calcitonin - It is confined to the thyroid gland - The cancer invades blood vessels
- The cancer invades blood vessels In follicular carcinoma of the thyroid, the cancer invades blood vessels and spreads to the bone and lung tissue. Papillary carcinoma is a slow-growing tumor confined to the thyroid gland. In medullary carcinoma, the tumor secretes calcitonin.
What should the nurse be aware of when caring for a patient with acute thyroiditis? - It is caused by a viral infection of the thyroid gland. - It is usually triggered by a bacterial or viral infection. - The condition is usually resolved with antibiotic therapy. - The thyroid gland feels hard and enlarged on palpation.
- The condition is usually resolved with antibiotic therapy. Acute thyroiditis is caused by bacterial invasion of the thyroid gland. It is usually resolved with antibiotic therapy. Subacute or granulomatous thyroiditis results from a viral infection of the thyroid gland. It usually occurs after a cold or other respiratory infection. Chronic thyroiditis of Hashimoto's disease is an autoimmune disorder. It is usually triggered by bacterial or viral infection. In subacute thyroiditis, the thyroid gland feels hard and enlarged on palpation.
Which eye assessment finding is known as a "globe lag"? - The patient has a wide-eyed, startled look at all times. - There is excessive tearing and the eyes appear bloodshot. - The upper eyelid fails to descend when the patient gazes down. - The upper eyelid pulls back faster than the eyeball gazes up.
- The upper eyelid pulls back faster than the eyeball gazes up. Globe or eyeball lag is a problem found in patients with hyperthyroidism and occurs when the upper eyelid pulls back faster than the eyeball gazes up. Eyelid retraction, or eyelid lag is a condition in which the upper eyelid fails to descend when the patient gazes down. Patients with photophobia have excessive tearing and eyes that appear bloodshot. Exophthalmos is common in patients with Graves' disease in which the patient has a wide-eyed, startled look at all times.
A patient's preliminary thyroid function test reveals a decrease in serum triiodothyronine (T3) and tetraiodothyronine (T4) hormone levels, which might indicate hypothyroidism. What other parameter should be assessed to determine the origin of hypothyroidism as primary or secondary? - Free T4 index - Thyrotropin receptor antibodies (TRAb) - Thyroid-stimulating immunoglobulins (TSI) - Thyroid-stimulating hormone (TSH) stimulation test
- Thyroid-stimulating hormone (TSH) stimulation test A TSH stimulation test is the only test which can differentiate between primary and secondary hypothyroidism. Primary hypothyroidism shows no response; whereas, secondary hypothyroidism elicits a normal response to a TSH stimulation test. The other options do not determine hypothyroidism to be either primary or secondary.
The nurse is caring for a patient diagnosed with Graves' disease. Which other term is used to define the patient's condition? - Toxic diffuse goiter - Hypothyroidism - Toxic multinodular goiter - Exogenous hyperthyroidism
- Toxic diffuse goiter Graves' disease, also known as toxic diffuse goiter, is an autoimmune disorder in which the thyroid gland enlarges to form a goiter and overproduces thyroid hormones. The disease is caused by hyperthyroidism. Hypothyroidism is a disorder caused by low levels of thyroid hormones. Toxic multinodular goiter is hyperthyroidism caused by multiple thyroid nodules. Exogenous hyperthyroidism is a condition caused by the excessive use thyroid replacement hormones.
What should be suspected in a 60 y/o female patient diagnosed with a goiter who does not display signs of exophthalmos and pretibial myxedema? - Graves' disease - Hypothyroidism - Hashimoto's thyroiditis - Toxic multinodular goiter
- Toxic multinodular goiter Toxic multinodular goiter typically presents without exophthalmos and pretibial edema and mostly occurs in patients previously suffering from goiter aged above 50 years. Graves' disease and hypothyroidism are not associated with goiter. Hashimoto's thyroiditis is a form hypothyroidism that typically affects women 30-50 years of age.
A patient with Graves' disease can potentially develop thyroid storm. What factor can trigger thyroid storm in the patient? - Lack of iodine - Use of artificial tears - Reduced room temperature - Vigorous palpation of the goiter
- Vigorous palpation of the goiter Vigorous palpation of the goiter can trigger a thyroid storm or thyroid crisis in a patient with Graves' disease. The manifestations of thyroid storm are caused by release of thyroid hormone in large amounts, increasing the metabolic rate. Exposure to iodine or radioactive therapy can trigger thyroid storm in the patient. Artificial tears are used to prevent dryness of the eyes in patient with exophthalmos; it does not cause thyroid storm. The patient with hyperthyroidism is intolerant to heat. Reduced room temperature provides comfort and would not cause thyroid storm.
Which are causes of hyperparathyroidism? SATA - Hypomagnesemia - Vitamin D deficiency - Congenital dysgenesis - Congenital hyperplasia - Neck trauma or radiation - Parathyroid tumor or cancer
- Vitamin D deficiency - Congenital hyperplasia - Neck trauma or radiation - Parathyroid tumor or cancer Causes of hyperparathyroidism include vitamin D deficiency, congenital hyperplasia, neck trauma or radiation, and parathyroid tumor or cancer. Both hypomagnesemia and congenital dysgenesis are causes of hypoparathyroidism, not hyperparathyroidism.
