Exam 4:Davis/Med Surg Sucess: Thyroid

1. When teaching a patient with hypoparathyroidism about the disorder, the nurse explains that blood calcium levels are altered because the role of parathyroid hormone is to

1. stimulate bone resorption and increase the calcium in the blood when blood calcium levels fall.

1. A patient has a total serum calcium level of 13.3 mg/dl (6.7 mEq/L, 3.3 mmol/L). The nurse understands that this level of calcium normally

1. stimulates the secretion of calcitonin.

1. A patient with hyperthyroidism is treated with radioactive iodine at a clinic. Before the patient is discharged, the nurse instructs the patient

1. to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance.

1. Special equipment that the nurse places in the patient's room before the patient returns to the surgical unit following a thyroidectomy includes

1. tracheostomy tray.

1. A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should

1. encourage the patient to drink 4000 ml of fluid daily.

1. A patient's T3 and T4 levels are decreased. The nurse understands that if the cause of the low thyroid hormone levels is a thyroid problem, further diagnostic testing would reveal

1. increased TSH levels.

15. A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypo- and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should

1.breathe in and out of a paper

1. The nurse identifies a nursing diagnosis of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves' disease. An appropriate nursing intervention to prevent this problem is to

1. teach the patient to sit upright as much as possible.

29. The nurse involved in helping the patient with hyperthyroidism with meal planning will encourage the patient to consume: A. clear liquid diet B Small, frequent meals high in protein and calories C.A diet rich in fiber and fat

(B) Small, frequent meals high in protein and calories Feedback: A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several well-balanced meals of small size. High-calorie, high-protein floods are encouraged. A clear liquid diet would not satisfy the patient's caloric or hunger needs. A diet rich in fiber and fat should be avoided as these foods may lead to gastrointestinal upset or increases peristalsis.

A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine prior to surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to

1. normalize metabolism and decrease the size and vascularity of the gland.

1. During the nursing assessment of a patient with Grave's disease, the nurse notes a bounding, rapid pulse and systolic hypertension. An additional manifestation of the disorder that the nurse would expect to find includes

1. patchy hair loss.

1. In hypothyroidism, the pt experiences a decrease in their basal metabolic rate, which will have affects that cause all of the following, EXCEPT

1. Excessive tearing of the eyes

1. During assessment of a patient's functional health patterns, a question by the nurse that addresses thyroid function is

1. "Do you experience fatigue even if you have slept a long time?"

1. Fourty eight hours after a thyroidectomy, a female pt complains of numbness and tingling in toes and fingers. As the nurse you also note upper arm and facial twitching. Your next action is

1. Report findings to dr immediately

1. When teaching a pt with hyperthyroidism about the diagnosis tests to be done, the nurse should include:

1. TSH and T3

1. During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. The nurse interprets this finding as

1. a normal finding.

1. The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to

1. assess respiratory status for signs of obstruction.

1. A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypo- and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should

1. breathe in and out of a paper bag to temporarily relieve the symptoms and then seek medical assistance.

Following a thyroidectomy, the patient develops hypoparathyroidism. The nurse teaches the patient that maintenance therapy for the hypoparathyroidism will include

1. calcium supplements.

1. After 5 years of experiencing depression, fatigue, and lethargy, an elderly woman is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. During initiation of thyroid replacement for the patient, it is most important for the nurse to assess

1. cardiovascular function.

1. While a 68-year-old woman is hospitalized for a fractured femur, she is diagnosed with hypothyroidism. A drug ordered for the patient at the time of admission that the nurse recognizes should not be administered without consulting the physician is

1. diazepam (Valium).

1. When teaching a patient with newly diagnosed hypothyroidism about management of the condition, the nurse should

1. provide written handouts of all instructions for continued reference as the patient improves.

10. Which of the following menu items would be the best source of iodine, which supports the function of the thyroid?

C) Table salt Feedback: The major use of iodine in the body is by the thyroid. Table salt is a source of iodine.

1. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include

administration of intravenous calcium gluconate.

28. The patient admitted with hypothyroidism complains of feeling cold. The nurse appropriately responds to this complaint by offering the patient: A Additional blankets B. Provide heating pads, electric blankets, C. hot water bottles

A) Additional blankets Feedback: The nurse should provide the patient with extra blankets and protect the patient from drafts. The use of heating pads, electric blankets, or hot water bottles must be avoided because of the risk of peripheral vasodilation, further loss of body heat, and vascular collapse. Furthermore, the patient could be burned by these items without being aware of it due to their potentially delayed responses and decreased mental status.

11. Which of the following assessments would indicate the patient was experiencing a thyroid storm?

A) Heart rate 140 beats/min, temperature 39o C, confusion Feedback: The following signs are suggestive of a thyroid crisis: tachycardia (heart rate more than130 beats/min), elevated temperature (more than 38.5o C), and exaggerated symptoms of hyperthyroidism.

14. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A patient with this endocrine dysfunction would experience:

A) Heat intolerance and systolic hypertension Feedback: An increased metabolic rate in hyperthyroidism because of excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss, not gain, occurs due to the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance. Heat intolerance and widened pulse pressure do occur, but the other answers are incorrect. Patients with hyperthyroidism experience an increase in appetite, not anorexia.

1. The nurse assesses the patient with Hashimoto's thyroiditis. Which of the following symptoms accompanies hypothyroidism?

A) Numbness and tingling in the fingers Feedback: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers.

5. The patient has returned from surgery following a total parathyroidectomy. The nurse should assess for which of the complications following this surgery?

A) Tetany Feedback: Care of postoperative patients having a parathyroidectomy is directed toward detecting early signs of hypoparathyroidism and subsequent hypocalcemia and anticipating signs of tetany, seizures, and respiratory difficulties.

19. The nurse's assessment of a patient after a thyroidectomy reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect what complication?

A) Tetany Feedback: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feeling of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism, not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

. What is the priority nursing diagnosis for the client newly diagnosed with hyperthyroidism?

A. Decreased cardiac output related to tachycardia Rationale: The cardiac problems of hyperthyroidism include increased systolic blood pressure, a widened pulse pressure, tachycardia, and other dysrhythmias. The goals of nonsurgical management are to decrease the effect of thyroid hormone on cardiac function and to reduce thyroid hormone secretion.

What is the priority nursing diagnosis for the client in thyroid crisis?

A. Potential for Ineffective Breathing Pattern Rationale: Thyroid crisis is a life-threatening emergency that has a 25% mortality rate even with intervention. Maintaining a patent airway and providing adequate ventilation are the primary concerns for clients in thyroid crisis.

2. A patient is diagnosed with Graves' disease. The nurse is aware the patient may have which of the following physical characteristics? C) Bulging eyes D) Fatigue

Ans: C Feedback: Clinical manifestations of the endocrine disorder Graves' disease include exophthalmos (bulging eyes) and fine tremor in the hands.

27. The nurse working in an ambulatory clinic recognizes which of the following patients as possessing a greater risk for the development of hypothyroidism? A.A 45 year old male B. A 45-year-old female C. 22 year old female

B) A 45-year-old female Feedback: Hypothyroidism affects women 5 times more frequently than men and occurs most often between 30 and 60 years of age. The 45-year-old female has a greater risk for the development of hypothyroidism.

4. A patient comes to the health clinic complaining of tremors and hyperexcitability. The nursing assessment reveals exophthalmos. The patient is exhibiting signs and symptoms of which of the following?

B) Hyperthyroidism Feedback: Tremors, hyperexcitability, and exophthalmos are signs and symptoms of hyperthyroidism.

18. The nurse is assessing a patient with hyperthyroidism. What findings should the nurse expect?

B) Weight loss, nervousness, tachycardia Feedback: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, cold intolerance, and decreased sweating are signs of hypothyroidism.

19. Which client is at greatest risk for hyperparathyroidism?

B. 45-year-old client receiving dialysis for end-stage renal disease Rationale: Clients who have chronic renal failure do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, which triggers overstimulation of the parathyroid glands.

Which clinical manifestation alerts you to the possibility of Grave's disease as the cause of hyperthyroidism?

B. Exophthalmos Rationale: Grave's disease causes edema in the extraocular muscles and increased retro-orbital fat that pushes the globe of the eye forward. This exophthalmos is not a feature of hyperthyroidism from any other cause.

The client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which of the following client reports alerts you to side effects of this therapy?

B. Increased thirst and urination Rationale: Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus.

Which of the following statements regarding thyroid disorders is true?

B. The effects of thyroid dysfunction are found in all body tissues and organs. Rationale: The presence of a goiter is associated with thyroid dysfunction; however, some types of hyperthyroidism cause a goiter and some types of hypothyroidism cause a goiter. Thyroid hormones affect virtually all metabolic processes in all body organs.

8. The patient who has long-standing hypothyroidism is at particular risk to develop what additional health problem?

C) Coronary artery disease Feedback: Any patient who has had hypothyroidism for a long period is almost certain to have elevated serum cholesterol levels, atherosclerosis, and coronary heart disease.

30. The nurse caring for a patient who had a thyroidectomy for thyroid cancer is aware that occasionally during thyroid surgery the parathyroid glands are injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A.Hypophosphatemia B.hyponatremia C.Hypocalcemia D.hypokalemia

C) Hypocalcemia Feedback: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline in calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, as laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not an expected response to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

9. Patients started on thyroid replacement therapy are watched for which of the following medication interactions?

C) Increase of the effects of anticoagulants Feedback: Thyroid hormones may increase blood glucose levels, increase susceptibility to all hypnotic agents, and increase the effects of anticoagulants. There is no information supporting nausea with acetaminophen ingestion.

3. The patient has returned following a thyroidectomy. How should the patient be positioned to promote comfort?

C) Semi-Fowler's with the head supported on two pillows Feedback: Semi-Fowler's position with the head elevated and supported by pillows is believed to provide the most comfort and least tension on the suture line.

The client scheduled to have a thyroid scan asks you how long she will be radioactive after the scan. What is your best response?

C. "The dose of radiation is so low and is excreted by the kidneys in just a few days, so you are not considered radioactive." Rationale: The radioactive iodine used in thyroid scans is low intensity and has such a short half-life that the client is not considered to be a radiation hazard and no radiation precautions are necessary.

What is the priority nursing diagnosis for the client with hypothyroidism?

C. Disturbed Thought Processes Rationale: Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. The client may be too lethargic, apathetic, or drowsy to recognize changes in his or her condition. Memory and attention span may be impaired. Paranoia and agitation also may be present. The client may have such disturbed thought processes that they are unable to care for themselves.

What dietary modification should you suggest for the client with hyperthyroidism?

C. Increase calories, proteins, and carbohydrates. Rationale: The client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance.

20. A 78-year-old male patient has been newly diagnosed with hypothyroidism. He lives in his own apartment in a community development designed for the elderly. He asks the nurse assigned to this complex for advice about his condition. What would be the best advice the nurse could give the patient?

D) "Increase fiber and fluids in your diet." Feedback: Patients with hypothyroidism typically have constipation. A diet high in fiber and fluids can help prevent this. Taking aspirin isn't related to hypothyroidism management. The patient doesn't need to discontinue all group activities, although he may need to limit them until his condition improves. Patients with hypothyroidism have an intolerance of cold and need an environment warmer than average.

32. A patient with hyperparathyroidism should be encouraged to comply with which level of activity? A. Best rest B. Limiting the patient to getting out of bed only a few times a day C. Vigourous activity D. Ambulation and activity, as tolerated

D) Ambulation and activity, as tolerated Feedback: Mobility of the patient, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

22. A patient with thyroid cancer undergoes a thyroidectomy. After surgery, the patient develops peripheral numbness and tingling and muscle twitching and spasms. The nurse should expect to administer: A.Thyroid supplementation B. An antispasmodic C. barbiturate D) IV calcium gluconate

D) IV calcium gluconate Feedback: Removal of the thyroid gland can cause hyposecretion of parathyroid hormone, leading to calcium deficiency. Symptoms of calcium deficiency include muscle spasms, numbness, and tingling. Treatment includes immediate IV administration of calcium gluconate. Thyroid supplementation (option A) is necessary following thyroidectomy but isn't specifically related to the identified problem. An antispasmodic (option B) doesn't treat the problem. A barbiturate (option C) isn't indicated.

9. The client scheduled for a partial thyroidectomy for hyperthyroidism asks you why she is being given an iodine preparation before surgery. What is your best response?

D. "To decrease the blood vessels in the thyroid and prevent excessive bleeding during surgery." Rationale: Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery.

17. Which clinical manifestation indicates to you that treatment for your client with hypothyroidism is effective?

D. The client has had a bowel movement every day for 1 week. Rationale: Hypothyroidism decreases gastrointestinal motility significantly. One of the parameters that clients can use to determine if changes in the dose of thyroid replacement should be adjusted is the frequency of bowel movements. A bowel movement every day is a strong indication that the dose of thyroid replacement hormone is adequate.

6. the hormone that tends to decrease calcium concentration in the blood is

a. Calcitonin

-pt is admitted with diagnosis of primary hyperparathyroidism. The nursing action that should be included in the plan of care is

a. seizure precaution

Nurse recognizes the need to decrease the thyroid gland prior to a thyroidectomy, would anticipate the dr ordering

a.Lugols iodine

on reviewing the meds for discharge with the pt newly diagnosed with HTN, the pt asks the nurse how long does he need to take the meds. Nurses best response is

a.must be taken until the dr d/c

2.when assessing a patient with hyperthyroidism, the nurse should expect the patient to exhibit

a.nervousness, weight loss, and increased appetite

3.patient following a subtotal thyroidectomy returns to her room after being in the recovery room for 2 hours what position in bed would be the best for this patient?

a.semi Fowler's

When teaching a patient newly diagnosed with Graves' disease about the disorder, the nurse explains that it is related to

development of thyroid-stimulating antibodies that cause growth and overproduction of the thyroid gland

1. Most appropriate diet for a pt with graves disease is

high calorie