Thyroid-NCLEX (in class)
These data are obtained by the RN who is assessing a client who had a trans-sphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? a. Dry lips and oral mucosa on examination b. Nasal drainage that tests negative for glucose c. Client report of a headache and stiff neck d. Urine specific gravity of 1.016
. Client report of a headache and stiff neck
The nurse is caring for a 56-year-old man receiving high-dose oral corticosteroid therapy to prevent organ rejection after a kidney transplant. What is most important for the nurse to observe related to this medication? A. Signs of infection B. Low blood pressure C. Increased urine output D. Decreased blood glucose
A. Signs of infection
1. The nurse is assessing the client for endocrine dysfunction. Which comment by the client indicates a need for further assessment? a. "I am worried about losing my job because of cutbacks." b. "I don't have any patience with my kids. I lose my temper faster." c. "I don't seem to have any stressors now." d. "My weight has been stable these past few years."
B "I don't have any patience with my kids, I lose my temper fast." *many endocrine problems can change a clients behavior, personality, & psychological responses.
TThe client has undergone a trans-sphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? A. Encourages the client to cough and deep-breathe B. Instructs the client not to strain during a bowel movement C. Instructs the client to blow his nose for postnasal drip D. Places the client in Trendelenburg position
B. Instructs the client not to strain during a bowel movement straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged.
The nurse is teaching the client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? A. "I should have more energy with this medication." B. "I should take it every morning." C. "If I continue to lose weight, I may need an increased dose." D. "If I gain weight and feel tired, I may need an increased dose."
C. "If I continue to lose weight, I may need an increased dose." Weight loss indicates a need for a decreased dose, not an increased dose.
Which information will the nurse teach a 48 year old patient who has been newly diagnosed with Graves disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.
C. Anti-thyroid medication may take several months for full effect Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen.
The surgeon 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? a. Assessing the patient's white blood cell levels and assessing for infection b. Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels c. Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia d. Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
C. Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia. Loss of the parathyroid gland is associated with hypocalcemia.
What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? a. Providing a dark, low-stimulation environment b. Closely monitoring the patient's intake and output c. Patient teaching related to levothyroxine (Synthroid) d. Patient teaching related to radioactive iodine therapy
C. Patient teaching related to levothyroxine (Synthroid). The rest are for hyper A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine (Synthroid).
Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? A. Bilateral exophthalmos B.Heart rate 136 beats/minute C. Temperature 103.8° F (40.4° C) D. Blood pressure 166/100 mm Hg
C. Temperature 103.8° F (40.4° C) The patients temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.
The nurse reviews the vital signs of the client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? A. Administers acetaminophen B. Alerts the Rapid Response Team C. Asks any visitors to leave D. Assesses the client's cardiac status completely
D. Assesses the client's cardiac status completely If the client's temperature has increased by even 1°, the nurse's first action is to notify the health care provider. Continuous cardiac monitoring should be the next step
A student nurse asks an RN on the medical-surgical floor what effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client. What effect does the RN tell the student nurse? A. Bradycardia and decreased level of consciousness B. Decreased respiratory rate C. Hypotension and shock D. Hypertension and heart failure
D. Hypertension and heart failure Hypertension and heart failure are a possibility if the dose is started too high or raised too rapidly because levothyroxine would essentially put the client into a hyperthyroid state.
A 50-year-old female patient smokes, is getting a divorce, and is reporting eye problems. On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? a. Puffy face, decreased sweating, and dry hair b. Muscle aches and pains and slow movements c. Decreased appetite, increased thirst, and pallor d. Systolic hypertension and increased heart rate
D. Systolic hypertension and increased heart rate. The patient's manifestations point to Graves' disease or hyperthyroidism, which would also include systolic hypertension and increased heart rate and increased thirst.
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness
b. Apical pulse rate In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias.
The nurse is caring for a 40-year-old man who has begun taking levothyroxine (Synthroid) for recently diagnosed hypothyroidism. What information reported by the patient is most important for the nurse to further assess? a. Weight gain or weight loss b Chest pain and palpitations c. Muscle weakness and fatigue d. Decreased appetite and constipation
b. Chest pain and palpitations
1. Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder? a. "What methods do you use to help cope with stress?" b. "Have you experienced any blurring or double vision?" c. "Have you had a recent unplanned weight gain or loss?" d. "Do you have to get up at night to empty your bladder?"
c. "Have you had a recent unplanned weight gain or loss?"
Which question from a nurse during a patient interview will provide focused information about a possible thyroid disorder? a. "What methods do you use to help cope with stress?" b. "Have you experienced any blurring or double vision?" c. "Have you had a recent unplanned weight gain or loss?" d. "Do you have to get up at night to empty your bladder?"
c. "Have you had a recent unplanned weight gain or loss?" Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland.
Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg
c. Temperature 103.8° F (40.4° C) The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately.
Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level
c. Thyroid-stimulating hormone (TSH) level
Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level
c. Thyroid-stimulating hormone (TSH) level A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH
Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? a. "I notice my breasts are tender lately." b. "I am so thirsty that I drink all day long." c. "I get up several times at night to urinate." d. "I feel a lump in my throat when I swallow."
d. "I feel a lump in my throat when I swallow."
The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? a. Client with Hashimoto's thyroiditis and a large goiter b. Client with hypothyroidism and an apical pulse of 51 beats/min c. Client with parathyroid adenoma and flank pain due to a kidney stone d. Client who had a parathyroidectomy yesterday and has muscle twitching
d. Client who had a parathyroidectomy yesterday and has muscle twitching A client who is 1 day postoperative for parathyroidectomy and has muscle twitching is showing signs of hypocalcemia and is at risk for seizures. Rapid assessment and intervention are needed.
The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? a. Client with Hashimoto's thyroiditis and a large goiter b. Client with hypothyroidism and an apical pulse of 51 c. Client with parathyroid adenoma and flank pain due to a kidney stone d. Client with parathyroidectomy yesterday who has muscle twitching
d. Client with parathyroidectomy yesterday who has muscle twitching
A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels. a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone
parathyroid hormone
Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? A. "I notice my breasts are tender lately." B. "I am so thirsty that I drink all day long." C. "I get up several times at night to urinate." D. "I feel a lump in my throat when I swallow."
"I feel a lump in my throat when I swallow." Difficulty in swallowing can occur with a goiter.
The client being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? A. Advises the client to go to a calming environment B. Asks whether the client has increased cold sensitivity or weight gain C. Instructs the client to see his health care provider immediately D. Tells the client to check the pulse again and call back later
B. Asks whether the client has increased cold sensitivity or weight gain Increased sensitivity to cold and weight gain are symptoms of hypothyroidism, indicating an over-correction of the medication. The client must be assessed further because he may require a lower dose of medication.
The client is 18 hours post parathyroidectomy. Which finding requires immediate attention? A. Edema at the surgical site B. Hoarseness C. Pain on moving the head D. Sore throat
B. Hoarseness Hoarseness or stridor is an indication of respiratory distress and requires immediate attention.
The patient has been feeling tired lately and has gained weight; reports thickened, dry skin and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first? a. Free thyroxine (FT4) b. Serum growth hormone (GH) c. Follicle stimulating hormone (FSH) d. Magnetic resonance imaging (MRI) of the head
a. Free thyroxine (FT4)
The patient has been feeling tired lately and has gained weight; reports thickened, dry skin and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first? a. Free thyroxine (FT4) b. Serum growth hormone (GH) c. Follicle stimulating hormone (FSH) d. Magnetic resonance imaging (MRI) of the head
a. Free thyroxine (FT4) The manifestations the patient is experiencing could be related to hypothyroidism. Free thyroxine (FT4) is considered a better indicator of thyroid function than total T4 and could be done to evaluate the patient for hypothyroidism.
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine(Synthroid)? a. Increased thyroxine (t4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
a. Increased thyroxine (t4) level. An increased thyroxine level indicates the levothyroxine dose needs to be decreased.
Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patient's T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland
a. New-onset changes in the patient's voice
Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patient's T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland
a. New-onset changes in the patient's voice Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression.
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. What potential problem should the nurse assess the patient for? a. Thyroid disorders b. Diabetes insipidus c. Pituitary dysfunction d. Parathyroid dysfunction
a. Thyroid disorders
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. What potential problem should the nurse assess the patient for? a. Thyroid disorders b. Diabetes insipidus c. Pituitary dysfunction d. Parathyroid dysfunction
a. Thyroid disorders Hyperthyroidism is associated with weight loss
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
b. Administer IV calcium gluconate.
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
b. Administer IV calcium gluconate. The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery.
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness
b. Apical pulse rate
A 37-yr-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon? a. Difficult to awaken. b. Increasing neck swelling. c. Reports 7/10 incisional pain. d. Cardiac rate 112 beats/minute.
b. Increasing neck swelling. The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction.
The client has undergone a trans-sphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? a. Encourages the client to cough and deep-breathe b. Instructs the client not to strain during a bowel movement c. Instructs the client to blow his nose for postnasal drip d. Places the client in Trendelenburg position
b. Instructs the client not to strain during a bowel movement
Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? a. The RN checks the blood pressure on both arms. b. The RN palpates the neck thoroughly to check thyroid size. c. The RN lowers the thermostat to decrease the temperature in the room. d. The RN orders nonmedicated eye drops to lubricate the patient's bulging eyes.
b. The RN palpates the neck thoroughly to check thyroid size.
A registered nurse (RN) is caring for a patient with a goiter and possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching? a. The RN checks the blood pressure in both arms. b. The RN palpates the neck to assess thyroid size. c. The RN orders saline eye drops to lubricate the patient's bulging eyes. d. The RN lowers the thermostat to decrease the temperature in the room.
b. The RN palpates the neck to assess thyroid size. Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows
c. Assess the patient's respiratory effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany.
These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? a. Dry lips and oral mucosa on examination b. Nasal drainage that tests negative for glucose c. Client report of a headache and stiff neck d. Urine specific gravity of 1.016
c. Client report of a headache and stiff neck Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care.
A student nurse asks an RN on the medical-surgical floor what effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client. What effect does the RN tell the student nurse? a. Bradycardia and decreased level of consciousness b. Decreased respiratory rate c. Hypotension and shock d. Hypertension and heart failure
d. Hypertension and heart failure Hypertension and heart failure are a possibility if the dose is started too high or raised too rapidly because levothyroxine would essentially put the client into a hyperthyroid state.
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? a. Iodine c. Propylthiouracil b. Methimazole d. Propranolol (Inderal)
d. Propranolol (Inderal) b-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm.
A 61-yr-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels. a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone
d. parathyroid hormone Parathyroid hormone (PTH) is the major controller of blood calcium levels.
