Chapter 45: Management of Clients with Thyroid and Parathyroid Disorders

10. In a client with Graves' disease receiving radioiodine, the nurse would monitor for the common treatment complication of a. hypothyroidism. b. skin breakdown. c. pulmonary emboli. d. urinary tract infection.

ANS: a Because radioiodine destroys thyroid cells, a major complications of 131I therapy is potential hypothyroidism. DIF: Cognitive Level: Comprehension REF: Text Reference: 1201 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. To increase the comfort of a client with exophthalmos, the nurse would a. elevate the head of the bed at night. b. provide warm soaks. c. restrict fluids. d. restrict activity.

ANS: a General nursing interventions also help to reduce eye discomfort and prevent corneal ulceration and infection in the client with exophthalmos. The nurse should elevate the head of the bed at night and have the client restrict salt intake to relieve edema. DIF: Cognitive Level: Comprehension REF: Text Reference: 1200 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

12. In caring for a client returning from surgery for a thyroid disorder, the nurse would have available, in case of emergency, the medication a. calcium gluconate. b. epinephrine. c. rectal aspirin. d. potassium chloride.

ANS: a Hypocalcemia can develop after thyroid surgery if the parathyroids are removed accidentally. The nurse should ensure that calcium gluconate ampules are available at the bedside and the client has a patent intravenous line. DIF: Cognitive Level: Application REF: Text Reference: 1204, 1205; TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

14. The nurse notes that a client who had thyroid surgery this morning has a weak voice quality. The nurse's most appropriate intervention is to a. encourage voice rest. b. start nasal oxygen. c. provide cool fluids. d. notify the physician immediately.

ANS: a If hoarseness or voice weakness is present, the nurse should reassure the client that the problem will probably subside in a few days. Unnecessary talking is discouraged to minimize hoarseness. DIF: Cognitive Level: Application REF: Text Reference: 1205 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

2. In a client admitted to the clinical unit with a sporadic goiter, the nurse might expect to find a. ingestion of a large amount of cabbage. b. residence in the Great Lakes region. c. a history of travel in a foreign country. d. a large intake of aspirin.

ANS: a 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. DIF: Cognitive Level: Comprehension REF: Text Reference: 1191 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. As part of the care plan to meet the needs of a client with myxedema, the nurse would a. set the thermostat between 75° and 80° F to provide a comfortable climate. b. suggest the consumption of dense fruit to decrease diarrhea. c. plan a strenuous exercise regimen to decrease weight. d. apply an astringent to the client's skin to promote dryness.

ANS: a The myxedematous client is hypothermic due to subnormal metabolism and needs a warmer environment for comfort. The myedematous client is constipated, has little energy, and has dry skin and hair. DIF: Cognitive Level: Application REF: Text Reference: 1194 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

21. When assessing a client's neck dressing the first day after thyroidectomy, the nurse would a. include the back of the neck and shoulders. b. ensure that the dressing is very tight. c. remove the dressing with each inspection. d. avoid using gloves to best detect moisture.

ANS: a The nurse should examine the back of the neck and shoulders for bleeding because blood tends to drain posteriorly. DIF: Cognitive Level: Application REF: Text Reference: 1204, Table 45-2; TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

1. The nurse performing assessment of a client notes that the thyroid gland is enlarged. The nurse would chart this finding as a. a goiter. b. a fibroma. c. Graves' disease. d. hyperthyroidism.

ANS: a Thyroid abnormalities are basically of three types: (a) enlargement of the thyroid (goiter), (b) hyperfunction, and (c) hypofunction. DIF: Cognitive Level: Knowledge REF: Text Reference: 1191 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. The nurse counseling a client in the prevention of goiter would suggest an increased intake of a. calcium. b. iodine. c. potassium. d. protein.

ANS: b Health promotion practices to prevent goiter include ingestion of iodized salt and avoidance of goitrogens. DIF: Cognitive Level: Knowledge REF: Text Reference: 1193 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

15. The nurse caring for a female client who had a total thyroidectomy 2 days ago would know to assess for tetany if a. the assessment indicates decreasing diastolic blood pressure. b. the client reports that her mouth has an odd sensation. c. the client reports a loss of appetite. d. the client reports increased thirst.

ANS: b Muscular twitching and hyperirritability of the nervous system may indicate hypocalcemic tetany. 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. DIF: Cognitive Level: Analysis REF: Text Reference: 1205 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

16. The nursing diagnosis Impaired Urinary Elimination has been assigned to the client with hyperparathryoidism. To address this diagnosis, the nurse would a. encourage the client to start and stop the urine stream. b. force fluids. c. not administer fluids with meals. d. withhold acidic juices in the diet.

ANS: 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. DIF: Cognitive Level: Application REF: Text Reference: 1212 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

20. In the teaching instructions for a client with hypoparathyroidism, the nurse would include a. a high-calcium, high-phosphorus diet. b. a high-calcium, low-phosphorus diet. c. a high-protein, high-calorie diet. d. a low-calcium, low-protein diet.

ANS: b The client with hypoparathyroidism should be on a diet high in calcium but low in phosphorus. DIF: Cognitive Level: Knowledge REF: Text Reference: 1215 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

5. In the assessment of a client with hypothyroidism, the nurse would include a. serum calcium levels. b. serum cholesterol. c. serum potassium levels. d. urine specific gravity.

ANS: 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. DIF: Cognitive Level: Application REF: Text Reference: 1194 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. The assessment that would prevent the nurse from administering the intravenous morphine sulfate ordered for pain to a client 2 hours after thryoidectomy is a. diastolic blood pressure of 92 mm Hg. b. respiration less than 12 breaths per minute. c. the client's complaint of pain when coughing. d. the client's complaint of nausea.

ANS: b The nurse should not give narcotics if the client has a respiratory rate of less than 12 breaths per minute or respiratory congestion. The morphine will probably remedy the blood pressure elevation and the nausea. DIF: Cognitive Level: Analysis REF: Text Reference: 1204, Table 45-2; TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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

ANS: b Weight loss occurs as a result of quickened metabolism in hyperthyroid clients. Manifestations include loose bowel movements, heat intolerance, profuse diaphoresis, tachycardia, and incoordination due to tremor. The skin becomes warm, smooth, and moist because of accelerated circulation to the tissues. Hair appears thin and soft. DIF: Cognitive Level: Comprehension REF: Text Reference: 1199 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. The nurse would remind a client that the preparation for thyroid surgery might take as long as a. 1 or 2 days. b. 1 week. c. 2 to 3 months. d. 6 months or longer.

ANS: c Adequate preoperative preparation may take as long as 2 to 3 months, although the final period of preparation for thyroid surgery is more intense and lasts about 10 days. DIF: Cognitive Level: Comprehension REF: Text Reference: 1200 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

9. 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).

ANS: 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. DIF: Cognitive Level: Knowledge REF: Text Reference: 1200 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

19. The nurse assessing a client for the presence of Chvostek's sign would a. check the client's pupil size. b. instruct the client to dorsiflex the foot. c. tap the side of the client's face. d. monitor the client's blood pressure.

ANS: c Chvostek's sign is spasms of facial muscle after a tap on the side of the face, signifying hyperirritability of the facial nerve. DIF: Cognitive Level: Knowledge REF: Text Reference: 1205 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

17. The nurse caring for a client with hyperparathyroidism should assign priority to a. coughing hourly. b. encouraging exercise. c. preventing falls. d. averting infection.

ANS: c 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. DIF: Cognitive Level: Analysis REF: Text Reference: 1211 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

3. The nurse should assess a client with a history of hypothyroidism for the metabolic condition of a. goiter. b. Graves' disease. c. Hashimoto's thyroiditis. d. myxedema.

ANS: d Myxedema is a complication of hypothyroidism characterized by a general hypometabolic state. DIF: Cognitive Level: Comprehension REF: Text Reference: 1193 TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. In making emergency equipment available at the bedside of a client who has undergone subtotal thyroidectomy, the nurse would include a. an electrocardiogram (ECG) monitor. b. a defibrillator. c. an intra-aortic balloon pump. d. a tracheostomy set.

ANS: d 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 tracheostomy set. DIF: Cognitive Level: Application REF: Text Reference: 1204, Table 45-2; TOP: Nursing Process Step: Intervention MSC: NCLEX: Safe, Effective Care Environment;

23. To aid in immobilizing the head of a client after thyroidectomy, the nurse would obtain a. Kerlix rolls. b. hand towels. c. a headboard. d. sandbags.

ANS: d The nurse should support the client's head and neck with pillows and sandbags after thyroidectomy. DIF: Cognitive Level: Application REF: Text Reference: 1204, Table 45-2; TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity

8. 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.

ANS: d Thyroid storm is a potentially fatal, acute episode of thyroid overactivity characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability. DIF: Cognitive Level: Application REF: Text Reference: 1200 TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity