Test 4--Thyroid and parathyroid--Old and New Book

In a client with Graves' disease receiving radioiodine, the nurse would monitor for the common treatment complication of A. hypothyroidism B. pulmonary emboli C. skin breakdown D. urinary tract infection

A Because radioiodine destroys thyroid cells, a major complication of 131I therapy is potential hypothyroidism.

A nurse is caring for a client with Graves' disease. Based on clinical manifestations, which nursing diagnosis would be most appropriate? A. altered body image B. constipation C. fluid volume deficit D. impaired nutrition--more than body requirements

A Clients with Graves' disease often have a startling appearance with a swollen neck, evidence of weight loss, and edematous protruding eyes. Clients may need much support to adjust to the physical changes that accompany this disease. They may have diarrhea, not constipation.

A client just returned from surgery for a thyroid disorder and complains that his/her mouth has an odd sensation. Which medication should the nurse anticipate administering? A. calcium gluconate B. epinephrine C. potassium chloride D. rectal aspirin

A Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations may develop 1 to 7 days after surgery. If the client develops positive Chvostek's or Trousseau's sign, numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the nurse should call the physician immediately and anticipate giving calcium gluconate. The nurse should ensure that calcium gluconate ampules are available at the bedside and the client has a patent intravenous line.

Self-care measures the nurse should teach a client with hypoparathyroidism include eating a A. high calcium, low phosphorus diet B. high phosphorous, high calcium diet C. low calcium low protien diet D. low protien, high caloire diet

A The client with hypoparathyroidism should be on a diet high in calcium but low in phosphorus.

A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? A. 75 yo female patient with osteoprorosis B. 50 yo male patient who is obese C. 45 yo female patient who used oral contraceptives D. 25 yo male patient who uses recreational drugs

A. 75 yo female patient with osteoporosis. Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women.

A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A. Do you feel any muscle twitches or spasms? B. Do you feel flushed or sweaty? C. Are you experiencing any dizziness or lightheadedness? D. Are you having any pain that seems to be radiating from your bones?

A. Do you feel any muscle twitches or spasms? As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimoto's thryoiditis. When assessing this patient, what sign or symptom would the nurse expect? A. Fatigue B. Bulging eyes C. Palpitations D. Flushed skin

A. Fatigue symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of fingers. Bulging eyes, palpitations, and flushed skin would be signs of hyperthyroidism.

The nurse counseling a client in the prevention of goiter would suggest an increased intake of A. calcium B. iodine C. potassium D. protein

B Health promotion practices to prevent goiter include ingestion of iodized salt and avoidance of goitrogens.

The nursing diagnosis Impaired Urinary Elimination has been assigned to the client with hyperparathyroidism. To address this diagnosis, the nurse would A. encourage the client to void frequently B. force fluids to 3 liters/day C. not administer fluids with meals D. withhold acidic juices in the diet

B The client should take in at least 3000 ml of fluid a day. Dehydration is dangerous for clients with hyperparathyroidism because it both increases the serum calcium level and promotes the formation of renal stones.

In the assessment of a client with hypothyroidism, the nurse would include A. serum calcium B serum cholesterol C. urine glucose D. urine specific gravity

B The most important changes caused by the decreased levels of thyroid hormone are those affecting lipid metabolism. There is a resultant increase in serum cholesterol and triglyceride levels and an increase in arteriosclerosis and coronary artery disease in clients with hypothyroidism.

In making emergency equipment available at the bedside of a client who has undergone subtotal thyroidectomy, the nurse would include A. defibrillator B. a tracheostomy set C. ECG monitor D. intra-aortic balloon pump

B The nurse should assemble the equipment at the bedside before the client returns from surgery. The equipment includes a blood pressure cuff and stethoscope, additional pillows, oxygen, suction equipment, intubation supplies, and a tracheostomy set.

The nurse's assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention? A. oral calcium chloride and vitamin D B. IV calcium gluconate C. STAT levothyroxine D. administration of parathyroid hormone (PTH)

B, IV calcium gluconate When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patient's immediate care? Select all that apply. A. administering diuretics to prevent fluid overload B. administering beta blockers to reduce heart rate C. administering insulin to reduce blood glucose levels D. applying interventions to reduce the patient's temperature E. administering corticosteroids

B,D Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patient's meal plan? A. A clear liquid diet, high in nutrients B. small, frequent meals, high in protein and calories C. Three large, bland meals a day D. A diet high in fiber and plant-sourced fat

B. Small, frequent meals, high in protein and calories. A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods 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 because these foods may lead to GI upset or increase peristalsis.

In the initial treatment of a teenager with hyperthyroidism, the nurse would anticipate using A. levothyroxine sodium (Synthroid) B. liothyronine sodium (Cytomel) C. methimazole (Tapazole) D. radioactive iodine (131i)

C Antithyroid therapy is recommended for hyperthyroid clients under 18 years of age and pregnant women. The major medications used to control hyperthyroidism include thioureas, propylthiouracil, and methimazole.

In a client admitted to the clinical unit with a sporadic goiter, the nurse might expect to find that the client A. frequently travels in foreign countries B. has a large intake of aspirin C. ingests a large amount of cabbage D. lives in the Great Lakes region

C Sporadic goiter is not restricted to any geographic area. Major causes include ingestion of large amounts of nutritional goitrogens, such as rutabagas, cabbages, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes. Aspirin intake is not related.

As part of the care plan to meet the needs of a client with mild hypothyroidism, the nurse would A. apply astringent to the client's skin to promote dryness B. plan a strenuous exercise regimen to decrease weight C. set the thermostat between 75 and 80 F to provide a comfortable climate D. suggest the consumption of dense fruit to decrease diarrhea

C The hypothyroidism client is hypothermic because of subnormal metabolism and needs a warmer environment for comfort. The client is also constipated, has little energy, and has dry skin and hair.

In a client with hyperthyroidism, the nurse would expect to see A. anorexia, constipation, and cold extremities B. blurred vision, night sweats, and palpitations C. heat intolerance, weight loss, and diarrhea D. muscle cramps, paresthesias, and numbness of the fingers and toes

C Weight loss occurs as a result of quickened metabolism in hyperthyroid clients. Manifestations include loose bowel movements, heat intolerance, profuse diaphoresis, tachycardia, and incoordination caused by tremor. The skin becomes warm, smooth, and moist because of accelerated circulation to the tissues. Hair appears thin and soft.

The nurse is assessing a patient diagnosed with Graves' disease. What physical characteristics of Graves' disease would the nurse expect to find? A. Hair loss B. Moon face C. bulging eyes D. Fatigue

C. Bulging eyes Clinical manifestations of the endocrine disorder Graves' disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves' disease is not associated with hair loss, a moon face, or fatigue.

A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hyponatremia B. Hypophasphatemia C. Hypocalcemia D. Hypokalemia

C. Hypocalcemia Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of 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, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient? A. side-lying with one pillow under the head B. head of the bed elevated 30 degrees and no pillows placed under the head. C. Semi-Folwer's with the head supported on two pillows. D. Supine, with a small roll supporting the neck.

C. Semi-Fowler's with the head supported on two pillows. When moving and turning the patient, the nurse carefully supports the patient's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler's position, with the head elevated and supported by pillows.

The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? A. Eggs B. Shellfish C. Table salt D. Red meat

C. Table salt The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.

The nurse caring for a client after a thyroidectomy plans care understanding that which of the following nursing diagnoses takes priority? A. acute pain B. imbalance nutrition C. impaired skin integrity D. risk for suffocation

D Although uncommon, there is a real risk of respiratory obstruction related to swelling at the surgical site or postoperative bleeding. Although all options are valid diagnoses, the airway diagnosis takes priority, particularly in the immediate postoperative period.

A nurse assessing a client finds a thyroid nodule that is hard, irregular, and painless. The nurse should suspect A. exophthalmos B. goiter C. hashimoto's thyroiditis D. thyroid cancer

D Clinical manifestations of thyroid cancers are a rapidly enlarging hard, irregular, painless nodule in an enlarged thyroid gland.

The nurse should assess a client with a history of hypothyroidism for A. goiter B. Grave's disease C. hashimoto's thyroiditis D. myxedema

D Myxedema is a complication of hypothyroidism characterized by a general hypometabolic state. Myxedema coma is a medical emergency that, if untreated, is nearly always fatal. Goiter is simply an enlarged thyroid gland. Graves' disease is the most common form of hyperthyroidism. Hashimoto's thyroiditis is a chronic condition.

The nurse caring for a client with hyperparathyroidism should assign priority to A. averting infection B. coughing hourly C. encouraging exercise D. preventing falls

D The client with hyperparathyroidism is at great risk for injury, leading to the nursing diagnosis Risk for Injury related to demineralization of bones resulting in pathologic fractures.

To aid in immobilizing the head of a client after thyroidectomy, the nurse would obtain A. headboard B. hand towels C. kerlix rolls D. sandbags

D The nurse should support the client's head and neck with pillows and sandbags after thyroidectomy.

In a newly admitted client with thyrotoxicosis, the nurse would plan to address the clinical manifestation of A. fluid overload B. hypothermia C. respiratory distress D. tachycardia

D Thyroid storm is a potentially fatal, acute episode of thyroid overactivity characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability.

The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? A. fluoroquinalone antibiotic B. a loop diuretic C. proton pump inhibitor D. benzodiazepine

D, benzodiazepine Oral thyroid hormones interact with many other medications.Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the same risk.

The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote? A. complete bed rest B. Bed rest with bathroom privileges C. Out of bed (OOB) to the chair twice a day D. Ambulation and activity as tolerated.

D. Ambulation and activity as tolerate. Mobility, 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. Bed 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.

A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patient's diminished thyroid function may have what effect? A. anaphylaxis B. nausea and vomiting C. increased risk of drug interactions D. prolonged duration of effect

D. prolonged duration of effect In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.