Sem 3 - Unit 2 - Hormonal Regulation - NCO

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Diarrhea 2 Listlessness 3 Weight loss 4 Bradycardia 5 Decreased appetite

1 Diarrhea 3 Weight loss Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

Which neurologic manifestation in a client is associated with hyperthyroidism? 1 Confusion 2 Hearing loss 3 Exophthalmos 4 Slowness of speech

3 Exophthalmos In hyperthyroidism, edema in the extraocular muscles and increased fatty tissue behind the eye leads to exophthalmos. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism.

The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? Select all that apply. 1 Emotional lability 2 Dyspnea on exertion 3 Abdominal distention 4 Decreased bowel sounds 5 Hyperactive deep tendon reflexes

1 Emotional lability 2 Dyspnea on exertion 5 Hyperactive deep tendon reflexes Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurologic manifestation related to excessive production of thyroid hormones. Abdominal distention is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.

Which physiologic responses should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1 Bradycardia 2 Blurred vision 3 Cold intolerance 4 Increased appetite 5 Widened pulse pressure

2 Blurred vision 4 Increased appetite 5 Widened pulse pressure Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate.

Propylthiouracil is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get radiation therapy?" What explanation does the nurse provide? 1 It binds previously formed thyroid hormones. 2 It decreases production of thyroid hormones. 3 Vascularity of the thyroid gland is decreased. 4 The need for thyroid iodine supplements is reduced.

2 It decreases production of thyroid hormones. Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.`

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? 1 Iodide solutions must be diluted in water and taken on an empty stomach. 2 Monitoring for signs of infection or bleeding is necessary. 3 Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy. 4 These drugs will be discontinued as soon as the temperature and pulse rate return to the expected range.

2 Monitoring for signs of infection or bleeding is necessary. Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

A client has a new diagnosis of hyperthyroidism. Which skin conditions should the nurse expect when performing a physical assessment? Select all that apply. 1 Warm 2 Moist 3 Pale 4 Smooth 5 Coarse 6 Dry

1 Warm, 2 Moist, 4 Smooth Hyperfunction of the thyroid gland causes diaphoresis, which makes the skin moist. Hyperthyroidism also causes smooth and warm skin. Pale, coarse, and dry skin is found with hypothyroidism.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client? 1 Thyroxine (T 4) and x-ray films 2 Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T 3) 3 Thyroglobulin level and PO 2 4 Protein-bound iodine and sequential multichannel autoanalyzer (SMA)

2 Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T 3) A decreased TSH assay together with an elevated T 3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T 4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. PO 2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. What is an action of PTU that the nurse will include in teaching? 1 Increases the uptake of iodine 2 Causes the thyroid gland to atrophy 3 Interferes with the synthesis of thyroid hormone 4 Decreases the secretion of thyroid-stimulating hormone (TSH)

3 Interferes with the synthesis of thyroid hormone PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.

A client with hyperthyroidism is being treated with propylthiouracil (PTU). What instruction should the nurse plan to include in the teaching plan regarding this drug? Select all that apply. 1 "Avoid abrupt discontinuation of the medication." 2 "Monitor your weight, pulse, and mood routinely." 3 "You can expect an immediate response to this medication." 4 "Also take an iodine replacement to aid metabolism of the drug." 5 "Report side effects, such as sore throat, fever, joint pain, or oral lesions.

1 "Avoid abrupt discontinuation of the medication." 2 "Monitor your weight, pulse, and mood routinely." 5 "Report side effects, such as sore throat, fever, joint pain, or oral lesions. Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T 3 (triiodothyronine) and T 4 (thyroxine). The therapeutic effect of the drug should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by drug-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this drug may take up to 3 weeks. Over-the-counter medications and seafood containing iodine should be avoided.

What clinical indicators should a nurse assess when caring for a client with hyperthyroidism? Select all that apply. 1 Dry skin 2 Weight loss 3 Tachycardia 4 Restlessness 5 Constipation 6 Exophthalmos

2 Weight loss 3 Tachycardia 4 Restlessness 6 Exophthalmos Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. 1 Use tinted glasses. 2 Use warm, moist compresses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. 5 Apply a petroleum-based jelly along the lower eyelid.

1 Use tinted glasses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly.