MCA-2 Adaptive Quiz #1 Disorders of the Thyroid and Parathyroid Glands

he nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective? "I should take my levothyroxine every morning before eating my breakfast." "I should only follow up with my doctor if I start having shortness of breath." "I should keep the air conditioning a few degrees colder to help me with sweating." "I should limit the amount of fiber I am eating to help keep me from getting constipated."

"I should take my levothyroxine every morning before eating my breakfast." Rationale A patient with a new diagnosis of hypothyroidism should be taught how to manage hypothyroidism, including taking the thyroid hormone in the morning before food. Patients with hypothyroidism need to be taught about the importance of regular follow-up care, not just when they are having abnormal symptoms. Patents with hypothyroidism should be taught to keep the environment warm and comfortable because of cold intolerance. Patients with hypothyroidism should increase the amount of fiber in their diet to prevent constipation; they should not limit the amount of fiber. p. 1170

Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? "I will use an enema for constipation." "I will use a sedative to treat insomnia." "I should take my thyroid medication in the morning before eating." "I should not switch to another brand of hormone unless I check with my health care provider."

"I will use an enema for constipation." Rationale Enemas are contraindicated for patients diagnosed with both cardiac disease and hypothyroidism. Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas. Using low-dose sedatives is recommended if the patient is experiencing insomnia. Thyroid medication should be taken in the morning before food. Switching to different brands is not recommended, because bioavailability may differ with different brands. pp. 1169, 1170

A patient has just begun long-term corticosteroid therapy. The nurse determines that the patient requires further education when making which statement? "I may need to monitor my blood sugar more frequently." "If I begin to gain weight I should stop taking my medication." "It is important that I stay away from people who have contagious illnesses." "I understand my appearance may change as fat tissue increases in my face and trunk."

"If I begin to gain weight I should stop taking my medication." Rationale Corticosteroids should be gradually tapered and not stopped suddenly to avoid life-threatening adrenal insufficiency. Corticosteroids may lead to insulin resistance and increased gluconeogenesis by the liver, and therefore the patient may need to monitor for blood sugar increase. Corticosteroids decrease the inflammatory response and delay healing, and therefore the patient is more susceptible to infections. Adipose tissue accumulates in the trunk, face, and cervical spine as a result of corticosteroid therapy. pp. 1179-1180

A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse? "You should notify your primary health care provider immediately." "You may need to have your thyroid removed sooner than anticipated." "It may take several weeks to see the full benefits of the treatment." "You don't feel any different? Would you like to sit down and talk about it?"

"It may take several weeks to see the full benefits of the treatment." Rationale Radioactive iodine has a delayed response, and the maximum effect may not be seen for up to three months. For this reason, it would not be necessary to contact the primary health care provider immediately, or for the patient to have the thyroid gland removed sooner. Asking the patient to sit and talk about it demonstrates that the nurse is being responsive to psychosocial/emotional needs, but is not the best nursing response at this time. p. 1166

The patient has a prescription for levothyroxine 37.5 mcg. Available are 0.075 mg tablets. How many tablets should the nurse administer? 0.25 tablet 0.5 tablet 0.75 tablet 1 tablet

0.5 tablet Rationale First, convert 0.075 mg to mcg, which equals 75 mcg. Using ratio and proportion, multiply 37.5 by x and multiply 75 × 1 to yield 37.5x = 75. Divide 75 by 37.5 to yield 0.5 tablet. p. 1169

A patient is prescribed levothyroxine. To promote optimal absorption, the nurse should instruct the patient to take the medication at which time? 0600 1200 1600 2100

0600 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. p. 1170

A patient who underwent thyroid surgery develops neck swelling. What is the first action that the nurse should take? Monitor calcium levels Evaluate difficulty in speaking Assess the patient for signs of hemorrhage Place the patient in a semi-Fowler's position

Assess the patient for signs of hemorrhage Rationale The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient. Monitoring calcium levels and evaluating difficulty in speaking helps in assessing the signs of hypoparathyroidism. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines. pp. 1167-1168 Correct (14)

The nurse is caring for a patient who is postoperative following a thyroidectomy. A priority of the patient's nursing care includes which action? Assessment of hoarseness Assessment of Babinski's reflex Assessment of Chvostek's sign Assessment of neck full range of motion Rationale

Assessment of Chvostek's sign Rationale A positive Chvostek's sign is a sign of life-threatening tetany, which could be caused by hypocalcemia because of accidental removal of the parathyroid glands. Hoarseness for three to four weeks postoperatively is an expected outcome of a thyroidectomy. A Babinski's reflex is not related to thyroid removal. Although it is advisable that the postoperative thyroidectomy patient exercise the neck muscles, neck flexion is contraindicated because it places tension on the suture line. pp. 1167-1168

An older adult patient who has a history of coronary artery disease (CAD) is diagnosed with hypothyroidism. What is appropriate for the nurse to include in the patient's education? Select all that apply. Eat a low-fiber diet. Avoid using enemas. Avoid using sedatives. Take the prescribed medication before breakfast. Alternate between the trade and generic brands of the medication.

Avoid using enemas. Avoid using sedatives. Take the prescribed medication before breakfast. Rationale An older adult patient diagnosed with both hypothyroidism and CAD should be taught to avoid enemas due to the risk of vagal stimulation, to avoid the use of sedatives for insomnia, and to take medication in the morning before breakfast. A high-fiber diet is recommended to avoid constipation. Different brands of hormones may have different bioavailability, and should be avoided. p. 1170

A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication? Seizures Cataracts Constipation Cardiac dysrhythmias

Cardiac dysrhythmias Rationale Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures and cataracts are complications seen in hypoparathyroidism. Constipation is not directly associated with parathyroid disorders. p. 1172

Which clinical manifestation is a classic finding in Graves' disease? Gingivitis Cretinism Exophthalmos Muscular dystrophy

Exophthalmos Rationale Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease. pp. 1163-1164

Activity intolerance in a patient with hypothyroidism is related to what? Fatigue Diarrhea Weight loss Nervousness

Fatigue Rationale Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness. p. 1170

A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent? Goiter Fibroma Thyrotoxicosis Hyperthyroidism

Goiter Rationale Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism. Goiter may be present in hyper- or hypofunction of the gland. A fibroma is a fibrous encapsulated connective tissue tumor not usually occurring in the thyroid gland. Thyrotoxicosis results from extreme hyperthyroidism or increased secretion of T3 and T4. Thyrotoxicosis is also known as thyroid storm or thyroid crisis. Hyperthyroidism is a condition resulting from an increase in production of T3 and T4. pp. 1162-1163

A patient is just returning to the surgical floor from the recovery room after undergoing a thyroidectomy. What is the nurse's priority nursing intervention? Have a tracheostomy tray at the bedside. Closely monitor the patient's emotional state. Avoid touching the patient's neck and shoulders. Maintain hydration status with small sips of water.

Have a tracheostomy tray at the bedside. Rationale Postoperative complications for a patient following a thyroidectomy include injury to the recurrent or superior laryngeal nerve, which can lead to vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy. Closely monitoring the patient's emotional status is important, especially because the appearance of the incision may be distressing to the patient. However, providing reassurance that the scar will fade in color and eventually look like a normal neck wrinkle is not the priority. Following surgery, patients are nothing by mouth status, and would not be taking small sips of water to maintain hydration. Hydration status is maintained via intravenous fluids. The nurse would not avoid touching the patient's neck and shoulders, because this would impede a thorough assessment. pp. 1166-1167

The nurse is caring for a patient who underwent removal of the thyroid gland (thyroidectomy) three days ago. The patient's serum chemistries reveal calcium of 3.2 mg/dL, potassium of 3.9 mEq/L, and phosphorus of 4.0 mg/dL. What condition do these findings indicate? Hypocalcemia Hypercalcemia Hyperkalemia Hypophosphatemia

Hypocalcemia Rationale Hypocalcemia is a low serum calcium level. Surgical removal of the thyroid gland may also include removal of the parathyroid gland. This results in a deficiency of parathyroid hormone, which controls serum calcium by regulating absorption of calcium from the gastrointestinal tract, mobilizing calcium in bones, and excreting calcium in breast milk, feces, sweat, and urine. The normal serum calcium level ranges from 9.0 to 11.5 mg/dL. Potassium is within normal limits (3.5 to 5 mEq/L), and phosphorus is also within normal limits (2.8 to 4.5 mg/dL). pp. 1167, 1168

A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? Exercise will be restricted for up to six months. A low- or no-sodium diet will be prescribed. Physical therapy will need to be continued. Life-long hormone replacement will be needed.

Life-long hormone replacement will be needed. Rationale This patient will need life-long thyroid hormone replacement with levothyroxine because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium-restricted diet would not ordinarily be necessary. pp. 1167-1168

The health care provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? Assessing the patient's white blood cell levels and assessing for infection Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Monitoring the patient's level of consciousness and assessing for acute delirium or agitation Rationale

Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Rationale Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia. p. 1173

What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? Providing a dark, low-stimulation environment Closely monitoring the patient's intake and output Patient teaching related to levothyroxine Patient teaching related to radioactive iodine therapy

Patient teaching related to levothyroxine Rationale A euthyroid state most often is achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism. pp. 1169-1170

In developing a teaching plan for the patient with exophthalmos, the nurse understands that the highest priority is placed on Avoiding eyestrain Improving self-esteem Preventing corneal injury Minimizing the risk of nerve damage

Preventing corneal injury Rationale The patient with exophthalmos may not be able to close the eyelids completely. This puts the patient at risk for dry eyes, for overexposure to environmental irritants, and for corneal injury. Lubricating eye drops can be used to combat drying, and dark glasses are encouraged to decrease exposure to environmental irritants. Preventing corneal injury is the priority for the patient with exophthalmos. Exophthalmos may create a function limitation in extraocular movements because of forward protrusion of the globe of the eye. The patient with exophthalmos is encouraged to move the eyes through the six cardinal fields of gaze several times a day to maintain ocular muscle flexibility. Avoiding eyestrain is not a priority for the patient with exophthalmos. Patients may suffer from decreased self-esteem because of the physical changes associated with exophthalmos. Good grooming is encouraged as a strategy to improve self-esteem. Improving self-esteem is of lower priority than preventing corneal injury. Exophthalmos is not associated with ocular nerve damage. p. 1164

Which parameter would indicate the optimal intended effect of therapy with levothyroxine? Blood pressure 120/78 mm Hg Weight loss of 5 pounds Thyroid-stimulating hormone (TSH) of 1.5 mIU/L White blood cell count 8000 mm 3

Thyroid-stimulating hormone (TSH) of 1.5 mIU/L Rationale Levothyroxine is a thyroid preparation used for hypothyroidism. A normal TSH level (between 0.4 to 4 mIU/L) indicates optimal intended effects of the medication. Weight loss, blood pressure, and a normal white blood cell count are not indicators of effective treatment with levothyroxine. pp. 1168-1169

A nurse is caring for a patient admitted for hyperthyroidism. What laboratory results will the nurse expect to see in the electronic chart to confirm hyperthyroidism? Select all that apply. Elevated TSH level Undetectable TSH level Low free thyroxine (free T 4) level Elevated free thyroxine (free T 4) level Low thyroid-stimulating hormone (TSH) level

Undetectable TSH level Elevated free thyroxine (free T 4) level Low thyroid-stimulating hormone (TSH) level Rationale The primary laboratory findings to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels and elevated free thyroxine levels. Low free thyroxine levels and elevated TSH levels are found with hypothyroidism. pp. 1164-1165

A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication? Vagus nerve stimulation Olfactory nerve stimulation Abducens nerve stimulation Hypoglossal nerve stimulation

Vagus nerve stimulation Rationale Constipation is a common problem associated with hypothyroidism. The use of enemas, however, is contraindicated because they result in vagus nerve stimulation for patients with a history of cardiac disease. Olfactory, abducens, and hypoglossal nerves are not affected by the use of enemas. p. 1170