PN 140 Test 3 Practice Questions: Part 2
The nurse is reviewing the history of a patient suspected of having hyperthyroidism. Which manifestation(s) would be supportive of the diagnosis? (Select all that apply.) A. Increased heart rate B. Increased appetite C. Emotional instability D. Mental sluggishness E. Hyperactivity with increasing sense of fatigue
A, B, C, E The earliest symptoms of hyperthyroidism may be weight loss (in spite of a good appetite) and nervousness. Symptoms can vary from mild to severe, and may include weakness, insomnia, tremulousness, agitation, tachycardia, palpitations, exertion-related dyspnea, ankle edema, difficulty concentrating, diarrhea, increased thirst and urination, decreased libido, scanty menstruation, and infertility. The condition is sometimes not diagnosed in its early stages because of the vagueness of the symptoms. In some cases, hyperthyroidism is misdiagnosed as a cardiovascular disease because symptoms for both conditions are similar. Hypothyroidism is associated with mental sluggishness.
The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.) A. Joint pain B. Liver toxicity C. Kidney damage D. Increased urination E. Bone marrow toxicity
A, B, E The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.
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, 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.
A 57-year-old man is admitted with a diagnosis of cirrhosis. The nurse is aware that he will most likely require which intervention(s)? (Select all that apply.) A. Diuretics B. Increased fluids C. Bleeding precautions D. Vegetable-based proteins E. Lactulose administration
A, C, D, E Because the liver produces clotting factors and is now dysfunctional, risk for bleeding exists. The liver cannot metabolize proteins, especially albumin, properly. This leads to edema and ascites and requires diuretics, preferably potassium wasting. Ammonia buildup is likely; lactulose binds with this toxic metabolic by-product and allows for its excretion through the GI tract. Patients with liver disorders are at high risk for fluid volume excess.
A patient is bought in by ambulance with a suspected brain injury. What are the outward symptoms of head injury? (Select all that apply.) A. Tinnitus B. Diarrhea C. Ottorhea D. Battle sign E. Chvostek sign
A, C, E The outward symptoms of head injury include tinnitus, ottorhea, and Battle sign. Diarrhea is not a symptom of head injury. Chvostek sign is used to assess for hypocalcemia.
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. "I will continue taking aspirin daily." The patient needs to be instructed NOT to take aspirin because it increases thyroid hormones. All the other statements are correct.
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. "I will take this medication at bedtime with a snack." Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid.
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. Agranulocytosis and aplastic anemia
What are the three most common symptoms of cancer of the pancreas? A. Dark urine, jaundice, and weight loss B. Jaundice, abdominal distention, and edema C. Dark stools, food intolerance, and weight loss D. Pruritus, right upper quadrant pain, and weight gain
A. Dark urine, jaundice, and weight loss Symptoms of pancreatic cancer include dark urine, jaundice, weight loss, epigastric pain, anorexia, vomiting, a dislike for red meat, glucose intolerance, clot formation, and clay-colored stools.
After a head injury, the patient begins to have drainage from the nose. The nurse assesses the drainage by which method? A. Halo test B. Tinel sign C. Battle sign D. Babinski sign
A. Halo test The halo test is used to determine whether drainage from the nose or ear is cerebrospinal fluid. Tinel sign is one assessment used during the assessment of carpal tunnel symptoms. Bruising behind the ear that occurs after a head injury is called Battle sign. Babinski sign is checked as part of a neurologic assessment.
The patient presents to the clinic with a gross enlargement of the anterior neck. The nurse knows that this is most likely caused by a deficiency in which substance? A. Iodine B. Sodium C. Calcium D. Vitamin D
A. Iodine A gross enlargement of the thyroid gland in the anterior neck is likely a goiter caused by iodine deficiency. The patient's symptoms are not caused by sodium, calcium, or vitamin D deficiencies.
The nurse is caring for a patient with late-stage cirrhosis. The nurse considers which factor when participating in a patient care conference? A. Late-stage cirrhosis is irreversible. B. Late-stage cirrhosis can be managed with lifestyle changes. C. Late-stage cirrhosis can be cured with lactulose and spironolactone. D. Late-stage cirrhosis is characterized by periods of remission alternating with flare-ups.
A. Late-stage cirrhosis is irreversible. After cirrhosis reaches the late stage, it is irreversible. Lactulose is used to manage ammonia levels and hepatic encephalopathy, but it is not curative. Cirrhosis does not have remission periods.
When planning care for the patient with acute pancreatitis, the LPN/LVN knows that which intervention is a priority of care? A. Pain control B. Nutritional supplementation C. Observation for mental changes D. Observation for intestinal obstruction
A. Pain control The patient with acute pancreatitis presents with pain. The intervention having the highest priority involves management of the pain. Nutritional supplementation and observation for mental changes and intestinal obstruction are appropriate interventions, but not the ones of highest importance.
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) Propylthiouracil (PTU) is the only anti-thyroid medication that can be used during the 1st trimester of pregnancy.
Which patient is the nurse most concerned with developing a subdural hematoma following an injury that resulted with a blow to the head? A. The 76-year-old patient who is taking an anticoagulant B. The 16-year-old football player who suffered a concussion C. The 36-year-old patient who has a history of migraine headaches D. The 56-year-old patient who is taking an antihypertensive medication
A. The 76-year-old patient who is taking an anticoagulant A subdural hematoma results when blood leaks under the dura mater (subdural) and presses against the softer arachnoid membrane and the brain tissue it is covering. As blood leaks, the hematoma grows in size. The 76-year-old patient is most at risk for a subdural hematoma due to his anticoagulant medication. The football player who suffered a concussion is at an increased risk for a head bleed, but less so than the elderly patient taking anticoagulant medication. The patients with migraine headaches and antihypertensive medications are not at an increased risk for hemorrhage.
A female patient with systemic lupus erythematosus (SLE) complains of photosensitivity. The LPN/LVN should instruct the patient on which self-care measure? A. Wear sunblock whenever she is outdoors. B. Include foods high in beta-carotene in her diet. C. Manage joint pain with prescribed medications. D. Use a tanning bed once per week to help with rashes.
A. Wear sunblock whenever she is outdoors. The patient with SLE should use a sunblock with an SPF of 30 or higher because direct sunlight can cause skin rashes and a generalized flare-up of the condition. Tanning beds should always be avoided. Foods high in beta-carotene will not help photosensitivity. Joint pain should be managed, but these medications will not prevent photosensitivity.
Major measures to help prevent cancer in patients should be taught by the nurse at every given opportunity. What are those things that should be taught to patients about the prevention of cancer? (Select all that apply.) A. Increase alcohol intake. B. Maintain a normal weight. C. Decrease ascorbic acid in the diet. D. Abstain from nitrite and nitrate food additives. E. Have your drinking water supply checked for contaminants.
B, D, E Major measures to help prevent cancer in patients should be taught by the nurse at every given opportunity. Those things that should be taught to patients about the prevention of cancer include moderation in drinking alcohol, increasing (not decreasing) ascorbic acid (vitamin C), maintenance of normal weight, checking the chemical makeup of the local water supply, and avoiding nitrite and nitrate food additives.
A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? A. "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." B. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." C. "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." D. "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."
B. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." PTU is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.
For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? A. Acute confusion B. Increased bruising C. Cardiac dysrhythmias D. Orthostatic hypotension
B. Increased bruising Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding. Bleeding commonly presents as bruising.
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? A. Lethargy B. Irritability C. Feeling cold D. Weight gain
B. Irritability Irritability is a symptom of hyperthyroidism and may indicate toxicity of the medication. The other choices are signs of hypothyroidism.
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).
When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? A. Kidney function B. Serum electrolytes C. Complete blood count (CBC) D. Brain natriuretic peptide
C. Complete blood count (CBC) With antithyroid medications, the nurse should monitor for possible serious adverse reactions such as agranulocytosis, leukopenia, and thrombocytopenia. An abnormal CBC result would indicate bone marrow dysfunction.
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. Grave's Disease
The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? A. Milk B. Eggs C. Chicken D. Seafood
D. Seafood Seafood contains high amounts of iodine. The other choices do not.
___________ 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 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.
For which reason are patients with esophageal varices prone to hemorrhage? A. They have portal hypotension. B. There is poor circulation within the veins. C. They are no longer able to produce vitamin K. D. There is an accumulation of ammonia in the blood.
C. They are no longer able to produce vitamin K. Esophageal varices are engorged veins (similar to varicose veins) that line the esophagus. They are the result of portal congestion and hypertension. The congestion can lead to massive bleeding when the vein walls rupture from increased pressure or esophageal irritation. Another factor in hemorrhage is that the liver is no longer able to make vitamin K. Ammonia buildup does not increase the patient's risk for hemorrhage.
A patient is 6 hours post-opt from a thyroidectomy. The surgical site is clean, dry and intact with no excessive swelling noted. What position is best for this patient to be in? A. Fowler's B. Prone C. Trendelenburg D. Semi-Fowler's
D. Semi-Fowler's
Which statement by a high school athlete being discharged after experiencing a concussion indicates a need for more teaching? 1. "I can go to football practice tomorrow." 2. "I need to report a worsening headache to the provider." 3. "I'll have to be awakened every few hours when asleep." 4. "I can expect to be more fatigued for a while."
Correct Answer: 1 (1) Any patient with a concussion should rest for 48 hours after the injury, and teenagers may take longer. The student may not return to practice or play until a physician's release is obtained. (2, 3, 4) Are commonly recommended practices and indications.
A nurse is reviewing medication orders for a female patient with SLE who is positive for the presence of antiphospholipid antibodies. The nurse would seek clarification from the provider about which type of medication? 1. Oral contraceptives 2. Hydroxychloroquine (antimalarial) 3. Glucocorticoid medication 4. NSAID
Correct Answer: 1 Women with lupus may need to have birth control with lower levels of estrogen to decrease flare-ups of systemic lupus erythematosus (SLE). (2) Hydroxychloroquine helps prevent organ damage in SLE. (3) Glucocorticoids help suppress the immune system, thereby lessening risk of flare-ups of SLE. (4) NSAIDs help in controlling paid associated with SLE.
A nurse keeps a postcraniotomy patient's neck in midline position and ensures that there is no excessive hip flexion. The rationale for the nurse's action would be that this position: 1. restores neutral position of the joints. 2. prevents a further increase in intracranial pressure. 3. promotes comfort and rest. 4. prevents the formation of blood clots.
Correct Answer: 2 (2) Keeping the neck in midline ensures proper drainage of fluids from the head; preventing excessive hip flexion seems to prevent increased intracranial pressure. (1) A neutral position is not necessarily recommended. (3) The midline position may not be comfortable for the patient. (4) The midline position does not prevent formation of blood clots.
A patient with high levels of serum ammonia asks, "Why do I have to continue taking lactulose?" What is the best response? 1. "It destroys ammonia-producing bacteria in the intestines." 2. "It reduces intestinal absorption of ammonia." 3. "It corrects vitamin B1 deficiency." 4. "It is used in preparation for a diagnostic test."
Correct Answer: 2 Lactulose is used to induce diarrhea and prevent diffusion of ammonia out of the intestinal tract. Neomycin is occasionally given orally or by enema to decrease the colonic bacteria. Thiamine is given to correct vitamin B1 deficiency. Lactulose does induce diarrhea, but it would not be the first choice for bowel preparation.
The nurse is reviewing the medications that each of her patients will receive during the shift. Which patient is likely to receive levothyroxine? 1. Patient who has von Recklinghausen disease 2. Patient who has hypothyroidism 3. Patient who has hyponatremia 4. Patient who has Graves disease
Correct Answer: 2 Levothyroxine is given to patients with hypothyroidism. Von Recklinghausen disease is hyperparathyroidism. Treatment may include infusion of isotonic sodium chloride and diuretic agents, phosphate therapy, and administration of calcitonin to decrease the rate of skeletal calcium release, or surgical removal of a major portion of the parathyroids. The underlying cause of hyponatremia must be determined, but fluid restriction and diuretics could be ordered if fluid overload is present. Graves' disease is a type of hyperthyroidism that may be treated with antithyroid drugs or radioactive iodine.
A patient has cirrhosis of the liver and ascites. The nurse should question which order? 1. Bed rest with bathroom privileges 2. Discontinue furosemide (Lasix) 80 mg 3. Give 2-g sodium diet 4. Fluid restriction 1500 mL/24 hr
Correct Answer: 2 Medical treatment includes administration of diuretics, bed rest, sodium, and fluid restriction.
There are two types of tumors: benign and malignant. A difference between the two types is: 1. malignant cells have a nucleus that is small and regular in shape, whereas benign cells are large and irregular. 2. malignant cells do not know when to stop multiplying, whereas benign cells have controlled patterns of reproduction and follow signals to stop. 3. malignant cells do not invade adjacent tissue, whereas benign cells sometimes do. 4. malignant cells reproduce exact copies, whereas benign cells become more disorganized with each succeeding generation.
Correct Answer: 2 One of the characteristics of malignant cells is that they become more and more undifferentiated as the malignancy progresses. The nucleus becomes large and irregular and they lose the trait of stopping reproduction upon command. (1) Malignant cells have a large nucleus. (3) Malignant cells can invade adjacent cells. (4) Benign cells are organized and malignant cells disorganized.
A 35-year-old woman reports episodes of emotional extremes with uncontrollable crying and depression followed by intense physical activity and euphoria. She complains of drying of the eyes and difficulty swallowing. Her symptoms confirm a nursing problem of altered coping. What is a cause for this diagnosis? 1. Parathyroid hormone deficiency 2. Excessive thyroid hormone secretion 3. Deficient estrogen production 4. Growth hormone deficiency
Correct Answer: 2 Patient has symptoms of hyperthyroidism. Parathyroid hormone is primarily involved with calcium regulation. Estrogen is associated with the female reproductive organs; changes in estrogen levels could contribute to mood but not the other symptoms. Growth hormone is responsible for tissue growth.
A 75-year-old patient who fell and hit his head a week ago is admitted for apparent personality changes, decreased level of consciousness, and irritability. The provider suspects a possible subdural hematoma. A family member asks about the condition. An accurate explanation would be: 1. "It is the presence of bleeding in the brain parenchyma." 2. "Bleeding occurs between the skull and the dura mater." 3. "It is the collection of blood between the brain and the inner surface of the dura mater." 4. "It is the intermittent blockage of circulation in various areas of the brain."
Correct Answer: 3 (3) A subdural hematoma occurs beneath the dura, between the brain and the dura. (1) The parenchyma is not between the brain and the inner surface of the dura mater. (2) The bleeding is on the other side of the dura mater. (4). A hematoma is not necessarily intermittent and occurs in a specific location.
The surgeon inserts an intraventricular catheter into the lateral ventricle of a patient with increased ICP. When asked by a relative about the procedure, an accurate response by the nurse would be: 1. "The catheter allows direct visualization of the brain tissue." 2. "The catheter is used to monitor brain waves." 3. "The catheter is used to remove excess fluid inside the brain." 4. "The catheter is used to infuse fluids and medications into the brain."
Correct Answer: 3 (3) An intraventricular catheter is used to drain off excess cerebral spinal fluid. (1) The catheter does not allow visualization of the brain tissue. (2) The catheter does not have a mechanism to monitor brain waves. (4). Fluids and medications are not infused into the brain through the intraventricular catheter.
A patient is scheduled for bone marrow biopsy to confirm the diagnosis of leukemia. As the nurse reinforces provider instructions regarding the procedure, an appropriate nursing statement regarding bone marrow biopsy would be: 1. "It is performed in the operating room." 2. "It is a painless procedure." 3. "It introduces a needle to aspirate tissue samples." 4. "It requires a surgical incision."
Correct Answer: 3 For the bone marrow biopsy, a small amount of tissue is pulled into a syringe through a needle that has been introduced into the bone marrow site. (1) This is not an instruction regarding the procedure. (2) This is not true and factual. (4) Bone marrow biopsy does not require a surgical incision.
A nurse provides patient instructions regarding taking iodine preparations. It is important for the nurse to include which instruction(s)? (Select all that apply.) 1. "Dilute the preparations well." 2. "Use a straw to prevent staining of the teeth." 3. "Watch for easy bruising." 4. "Report severe epigastric pain." 5. "Anticipate a metallic taste."
Correct Answers: 1, 2, 4, 5 Iodine preparations should be given well-diluted and administered through a straw, as they can stain the teeth. Adverse effects of iodine preparations can include gastrointestinal upset, metallic taste, skin rashes, allergic reactions, and epigastric pain. Iodine does not cause bruising.
A nurse is caring for a patient after a thyroidectomy. What should the nurse monitor for? (Select all that apply.) 1. Bleeding and swelling 2. Hypothermia 3. Increase in pulse 4. Difficulty swallowing 5. Difficulty breathing
Correct Answers: 1, 3, 4, 5 Watch for signs of bleeding and swelling at the operative area. Any rise in temperature, pulse, or respiration rate should be reported immediately, as it may indicate a high level of thyroxine in the bloodstream. External swelling may cause constriction of the bandage around the neck. Difficulty in swallowing or breathing also should be reported immediately, as it may indicate internal edema and pressure on the esophagus and trachea. There would be no reason for the patient to be hypothermic.
A patient received large doses of radioactive iodine (131I) for hyperthyroidism. Which nursing intervention(s) should be included? (Select all that apply.) 1. Monitor vital signs. 2. Restrict fluids. 3. Encourage low-fat, high-fiber diet. 4. Properly handle contaminated materials. 5. Encourage physical activity.
Correct Answers: 1, 4 Vital signs are monitored in all postprocedure patients; however, in this case the nurse should be vigilant for thyroid crisis. The radioactive substance is excreted via the urinary system, so contaminated equipment must be handled properly. Fluid and diet do not play a role in the therapy. There is no procedural benefit from increased physical activity.
A patient with an immune disorder is very susceptible to infection. Which intervention(s) would be used in the care of this patient? (Select all that apply.) 1. All health care workers should perform scrupulous hand hygiene. 2. The patient should be instructed on how to wear PPE. 3. The patient is placed in Contact Isolation as soon as possible. 4. Caregivers with any type of infection should not be assigned to the patient. 5. A high-protein diet with nutritional supplements is encouraged.
Correct Answers: 1, 4, 5 Performing hand hygiene, providing protection from exposure to known infectious sources, and giving protein to make antibodies and strengthen the immune system are appropriate interventions. (2) The patient generally will not don PPE (those entering the room will don PPE). (3) The patient will be placed in transmission-based isolation, not Contact Isolation.
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? A. "I will take a double dose to make up for the missed one." B. "I can expect improvement of my symptoms within 1 week." C. "I will stop the medication immediately if I feel pain or weakness in my muscles." D. "I will take this medication in the morning so it does not affect my sleep at night."
D. "I will take this medication in the morning so it does not affect my sleep at night." Levothyroxine increases basal metabolic rate and thus may cause insomnia. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.
A patient who has been prescribed an antineoplastic drug for his newly diagnosed cancer asks the nurse what the most common side effect is for these drugs. What is the nurse's most accurate response? A. "An elevated temperature is a common side effect." B. "Gastrointestinal upset is the most common side effect." C. "These drugs almost always cause a vitamin B12 deficiency." D. "Most of these drugs cause some degree of bone-marrow depression."
D. "Most of these drugs cause some degree of bone-marrow depression." All antineoplastic drugs cause bone-marrow depression. The degree of bone-marrow depression depends on the drug and dosage. Gastrointestinal upset is experienced with some neoplastic drugs. An elevated temperature is a sign of infection, and vitamin B12 deficiency is not commonly a side effect.
In the postoperative period, the LPN/LVN should observe a patient who has had a thyroidectomy for which signs of thyroid crisis? A. Depression and fatigue B. Respiratory distress and hoarseness C. Twitching of muscles and severe convulsions D. Extreme temperature elevation and rapid pulse rate
D. Extreme temperature elevation and rapid pulse rate Thyroid storm (TS), also known as thyroid crisis or thyrotoxicosis, is another complication following a thyroidectomy. In the postoperative setting, the condition is caused by a sudden increase in the output of thyroxine caused by manipulation of the thyroid as it is being removed. Another cause of TS may be improper reduction of thyroid secretions before surgery. The symptoms of TS are produced by a sudden and extreme elevation of all body processes. The temperature may rise to 106° F (41.1° C) or more, the pulse increases to as much as 200 beats/min, respirations become rapid, and the patient exhibits marked apprehension and restlessness. Unless the condition is relieved, the patient quickly passes from delirium to coma to death from heart failure. Respiratory distress is a complication of thyroidectomy if the edema affects the airway, but it is not a sign of thyroid storm. Muscle twitching and convulsions are a sign of hypocalcemia from hyperparathyroidism. Hoarseness is an expected finding following thyroidectomy. Depression and fatigue may result from hypothyroidism.
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism
D. Hypothyroidism Iodine helps make T3 and T4....if a person does not consume enough iodine they are at risk for developing HYPOTHYROIDISM.
A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because? A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia. B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.
D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.
Which condition is NOT a known cause of cirrhosis? A. Obesity B. Alcohol consumption C. Blockage of the bile duct D. Hepatitis C E. All are known causes of cirrhosis
E. All are known causes of cirrhosis
A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices
The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.
A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient? A. Beef tips and broccoli rabe B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts
The answer is A. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.
While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as: A. Steatorrhea B. Melena C. Currant D. Hematochezia
The answer is A. Steatorrhea is an oily/greasy appearance of the stool which can occur in chronic pancreatitis. This occurs due to the inability of the pancreas to produce digestive enzymes which help break down fats. Fats are not being broken down; therefore, it is being excreted into the stool. Melena is used to describe tarry/black stool, hematochezia is used to describe red stools, and currant are jelly type stools.
A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority you? A. Reassure the patient this is normal with pancreatitis B. Check the patient's blood glucose C. Assist the patient with drinking a simple sugar drink like orange juice D. Provide a dark and calm environment
The answer is B. Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.
During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings? A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level
The answer is C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.
Which of the following is NOT a role of the liver? A. Removing hormones from the body B. Producing bile C. Absorbing water D. Producing albumin
The answer is C. The liver does not absorb water. The intestines are responsible for this function.
The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? A. Abdominal girth is decreased B. Skin turgor is less than 2 seconds C. Blood glucose is 250 D. Stools appear formed and solid
The answer is D. Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed.
You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse
The answer is D. Main causes of acute pancreatitis are gallstones and alcohol consumption. Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.
Which of the following are treatment options for hyperthyroidism? Please select all that apply: A. Thyroidectomy B. Methimazole C. Liothyronine Sodium "Cytomel" D. Radioactive Iodine
The answers are A, B,and D. Liothyronine Sodium "Cytomel" is a treatment for hypothyroidism. All the other options are for hyperthyroidism.
Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply : A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia
The answers are A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).
You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply: A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes
The answers are B, C, and E. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).
A patient who has hyperthyroidism exhibits symptoms of anxiety, nervousness, and agitation. Which intervention should be included in the patient's care? A. Keeping environmental stimuli to a minimum B. Encouraging questions about options for treatment C. Stressing the importance of complying with the treatment regimen D. Maintaining the temperature of the room slightly above normal
a. Keeping environmental stimuli to a minimum The patient with hyperthyroidism may experience nervousness and irritability. The patient will benefit from having the environmental stimuli kept to a minimum. Although encouraging questions and stressing treatment compliance are appropriate interventions for this patient, they are not the most appropriate for the anxiety symptoms the patient is experiencing. The patient will be more comfortable with a room temperature slightly below normal.
The nurse is assessing a 64 year-old patient who will be starting thyroid replacement therapy. Which statement is true regarding the dosage of thyroid replacement hormones for the older adult? a. Thyroid hormone replacement requirements are approximately 25% lower for this age group. b. Older adults require higher dosages of thyroid replacement hormone for therapeutic effects. c. There is no difference in the dosage of thyroid replacement hormone in older adults versus younger adults. d. The dosage of thyroid hormone will depend upon the amount of iodine in the patient's diet.
a. Thyroid hormone replacement requirements are approximately 25% lower for this age group.
The nurse is teaching a patient who has a new prescription for the antithyroid drug propylthiouracil (PTU). Which statement by the nurse is correct? a. "There are no food restrictions while on this drug." b. "You need to avoid foods high in iodine, such as iodized salt, seafood, and soy products." c. "This drug is given to raise the thyroid hormone levels in your blood." d. "Take this drug in the morning on an empty stomach."
b. "You need to avoid foods high in iodine, such as iodized salt, seafood, and soy products."
When monitoring the laboratory values for a patient who is taking antithyroid drugs, the nurse knows to watch for a. increased platelet counts. b. increased white blood cell counts. c. increased blood urea nitrogen level. d. increased blood glucose levels.
c. increased blood urea nitrogen level.
To help with the insomnia associated with thyroid hormone replacement therapy, the nurse will teach the patient to a. take half the dose at lunchtime and the other half 2 hours later. b. use a sedative to assist with falling asleep. c. take the dose upon awakening in the morning. d. reduce the dosage as needed if sleep is impaired.
c. take the dose upon awakening in the morning.
The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what to do. Which is the best response by the nurse? a. "Go ahead and take the other brand that the pharmacy has available for now." b. "You can stop the medication until your current brand is available." c. "You can split the thyroid pills that you have left so that they will last longer." d. "Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands."
d. "Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands."
