Chapter 63 Care of Patients with Problems of the Thyroid and Parathyroid Glands
a nurse is assessing a client for possible laryngeal nerve injury following a thyroidectomy. which action should the nurse implement on an hourly basis?1. ask the client to speak2. instruct the client to swallow3. have the client hum a familiar tune4. swab the clients throat to test the gag reflex
1
a nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. which action should be included in this clients plan of care?1. ensuring a large fluid intake2. providing a high-calcium diet3. instituting seizure precautions4. encouraging complete bed rest
1
a nurse is caring for a client who just had a thyroidectomy. for which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?1. tetany2. myxedema3. hypovolemic shock4. adrenocortical stimulation
1
a nurse is caring for a newly admitted client with a diagnosis of graves disease. in preparing a teaching plan, the nurse anticipates which diet will be ordered for this client?1. high calorie diet2. low sodium diet3. high roughage diet4. mechanical soft diet
1
when taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. the nurse notifies the health care provider. which should the nurse expect the health care provider to prescribe?1. calcium2. magnesium3. bicarbonate4. potassium chloride
1
a nurse is assessing a client with a diagnosis of hypothyroidism. which clinical manifestations should the nurse expectt when assessing this client? (SATA)1. dry skin2. brittle hair3. weight loss4. resting tremors5. heat intoleranc
1, 2
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? (SATA)1. use tinted glasses2. use warm, moist compresses3. elevate the head of the bed 45 degrees4. tape eyelids shut at night if they do not close5. apply a petroleum-based jelly along the lower eyelid
1, 3, 4
Which actions should you delegate to the LPN/LVN for the care of a patient with hypothyroidism? (Select all that apply.)1. Assessing and recording the rate and depth of respirations2. Auscultating lung sounds every 4 hours3. Creating an individualized nursing care plan for the patient4. Administering sedation medications every 6 hours5. Checking blood pressure, heart rate, and respirations every 4 hours6. Reminding the patient to report any episodes of chest pain or discomfort
1,2,6
Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. the client asks the nurse "why do i have to ask to take this medication if i am going to get the atomic cocktail?" the nurse explains that the medication is being prescribed because it decreases the 1. vascularity if the thyroid gland 2. production if thyroid hormones 3. need for thyroid idoine supplements
2
a client with hyperthyroidism asks the nurse about the tests that will be ordered. which diagnostic tests should the nurse include in a discussion with this client?1. T4 and xray films2. TSH assay and T33. Thyroglobulin level and po24. protein-bound iodine and SMA
2
a client is scheduled to have a thyroidectomy. which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery?1. vasopressin (Pitressin)2. propylthiouracil (PTU)3. potassium iodide (SSKI)4. levothyroxine (Synthroid)
3
a nurse is caring for a client after radioactive iodine is administered for graves disease. what information about the clients condition after this therapy should the nurse consider when providing care?1. not radioactive and can be handled as any other individual2. highly radioactive and should be isolated as much as possible3. mildly radioactive but should be treated with routine safety precautions4. not radioactive but may still transmit some dangerous radiations and must be treated with precautions
3
for which client response should the nurse monitor when assessing for complications of hyperparathyroidism?1. tetany2. seizures3. bone pain4. graves disease
3
on the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. this is changed to a soft diet on the second postoperative day. the client reports having a sore throat when swallowing. what should the nurse do first?1. reorder the full fluid diet2. notify the health care provider3. administer analgesics as prescribed before meals4. provide saline gargles to moisten the mucous membranes
3
what should a nurse do immediately when a client returns from the postanesthesia care unit following a subtotal thyroidectomy?1. inspect the incision2. instruct the client not to speak3. place a tracheostomy set at the bedside4. place in the supine position for 24 hours
3
A nurse is caring for a client with an under-active thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3) and thyroxine (T4)? Select all that apply. 1. Irritability 2. Tachycardia 3. Weight gain 4. Cold intolerance 5. Profuse diaphoresis
3, 4
a nurse in the postanesthesia care unit is caring for a client who just had a thyroidectomy. for which client response is it most important for the nurse to monitor?1. urinary retention2. signs of restlessness3. decreased blood pressure4. signs of respiratory obstruction
4
a clients laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. for what clinical manifestations should the nurse assess this client? (SATA)1. muscle tremors2. abdominal cramps3. increased peristalsis4. cardiac dysrhythmias5. hypoactive bowel sounds
4, 5
Levothyroxine (Synthroid) 0.125 mg by mouth is prescribed for a client with hypothyroidism. The only tablets available contain 25 mcg per tablet. how many tablets should the nurse administer?
5 tablets
A patient has the following assessment findings: elevated TSH level, low T3 and T4 levels, difficulty with memory, lethargy, and muscle stiffness. There are clinical manifestations of which disorder? A. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism
A
In addition to regulation of calcium levels, PTH and calcitonin regulate the circulating blood levels of which substance? A. Potassium b. Sodium c. Phosphate d. Chloride
c
The nurse assesses a patient in the ED and finds the following; constipation, fatigue with increased sleeping time impaired memory, facial puffiness, and weight gain. Which deficiency does the nurse recognize? A. Hyperthyroidism b. Hypothyroidism c. Hyperparathyroidism d. Hypoparathyroidism
B
Which factor is a main assessment finding that signifies hypothyroidism? A. Irritability b. Cold intolerance c. Diarrhea d. Fatigue
B
A patient with exophthalmos from hyperthyroidism reports dry eyes, especially in the morning. The nurse teaches the patient to perform which intervention to help correct this problem? A. Wear sunglasses at all times when outside in the bright sun b. Use cool compresses to the eye four times a day c. Tape the eyes closed with nonallergenic tape d. There is nothing that can be done to relieve this problem.
C
Which laboratory result is consistent with a diagnosis of hyperthyroidism? A. Decreased serum T3 and T4 levels b. Elevated serum TRH level c. Decreased radioactive iodine uptake d. Increased serum T3 and T4
D
A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine? 1. Myxedema 2. Acromegaly 3. Graves disease 4. Cushing disease
a
After a visit to the health care provider's office, a patient is diagnosed with general thyroid enlargement and elevate thyroid hormone level. Which condition do these findings indicate? A. Hyperthyroidism and goiter b. Hypothyroidism and goiter c. Nodules on the parathyroid gland d. Thyroid or parathyroid cancer
a
Production of which hormones causes lower levels of calcium? A. Calcitonin b. parathyroid hormone (PTH) c. thyroxine (T4) d. Thyroid stimulating hormone (TSH)
a
The clinical manifestations of hyperthyroidism are known as which condition? A thyrotoxicosis. B. Euthyroid function c. Graves' disease d. Hypermetabolism
a
The nurse is orienting a new graduate RN who is providing care for a postoperative patient after a thyroidectomy. the new grduate assesses the patient and notes laryngeal stridor with a pulse ox of 89%. What is the priority action for the nurse and new graduate? a. immediately notify rapid response b. apply oxygen by face mask c. prepare ti suction the patient d. assess for numbness and tingling around the mouth
a
The unlicensed assistive personnel (UAP) is providing a bath for a patient with hyperparathyroidism. What essential teaching must the nurse provide to the UAP? a. handle the patient carefully and use a lift sheet for repositioning b. be sure to use a bath blanket to keep the patient from shivering c. remind the patient about the importance of consuming foods rich in potassium d. allow the patient to get out of bed and walk to the bathroom without assistance
a
Which change in VS would you instruct the UAP to report immediately for a patient with hyperthyroidism? A. Rapid HR B. Decreased systolic BP C. Increased RR D. Decreased oral temperature
a
You are caring for a patient with hyperthyroidism who had a partial thyroidectomy yesterday. Which change in assessment would you report to the health care provider immediately?1. Temperature elevation to 100.2° F2. Heart rate increase from 64 beats/min to 76 beats/min3. Respiratory rate decrease from 26 breaths/min to 16 breaths/min4. Pulse oximetry reading of 92%
a
You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring by a nurse? 1. Calcium level 2. Sodium level 3. Potassium level 4. White blood cell count
a
Which clinical findings should the nurse expect when assessing a client with hyperthhroidism? SATA a diarrhea b. listlessness c. weight loss d. bradycardia e. decreased appetite
a, c
The nurse is assessing a patient after thyroid surgery and discovers harsh, high-pitched respiratory sounds. What is the nurses best first action? A. Administer oxygen at 5L via nasal cannula b. Administer IV calcium chloride c. Notify the Rapid Response Team D. Suction the patient for oral secretions
c
Which assessment finings of hypocalcemia? (SATA) a. Numbness and tingling around the mouth b. muscle cramping c. Bone fractures d. fever e. Tachycardia
ab
Which disorders/conditions can cause hyperparathyroidism? (SATA) a. Chronic kidney diseases b. Neck trauma c. Thyroidectomy d. Vitamin D deficiency e. Parathyroidectomy
abd
Which statement about thyroiditis are accurate? (SATA) a. It is an inflammation of the thyroid gland b. Hashimoto's disease is the most common type c. IT always resolves with antibiotic therapy d. There are three types: acute, subacute, and chronic. E. The patient must take thyroid hormones
abde
Which statements about hypothyroidism are accurate? (SATA) a. It occurs more often in women b. It can be caused by iodine deficiency c. Weight loss is a common manifestation d. It can be caused by autoimmune thyroid destruction e. Myxedema coma is a rare but serious complication
abde
Which statements about hyperthyroidism are accurate? (SATA) a. It is most commonly caused by Graves' disease b. It can be caused by overuse of thyroid replacement medication c. It occurs more often in med between the ages of 20-40 d. Weight gain is a common manifestation e. Serum T3 and T4 results will be elevated
abe
Discharge planning for a patient with chronic hypoparathyroidism includes which instructions? (SATA) a. Prescribed medications must be taken for the patient entire life b. Eat foods low in vitamin D and high in phosphorous c. Eat foods high in calcium, but low in phosphorous d. After several weeks, medications can be discontinued e. Kidney stones are no longer a risk to the patient
ac
Which signs and symptoms are assessment findings indicative of thyroid storm? (SATA) a. Abdominal pain and nausea b. Hypothermia c. Elevated temperature d. Tachycardia e. Elevated systolic blood pressure f. Bradycardia
acde
A patient who has been diagnosed with Graves disease is to receive RAI in the oral form of 131I. What does the nurse teach the patient about how this drug works? a. it destroys the hormones T3 and T4 b. it destroys the tissue that produces thyroid hormones c. it blocks thyroid hormone production d. it prevents T4 from being converted to T3.
b
For a patient with hyperthyroidism, which ask will you delegate to an experienced UAP? A. Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or chest pain B. Monitoring the apical pulse, BP, and temp every 4 hours C. Drawing blood to measure levels of TSH, T3, and T4 D. Teaching the patient about side effects of the drug propylthiouracil (PTU)
b
The nurse assesses a newly admitted patient with a diagnosis of hypertyroidism. How would the nurse best document the finding in this patient (PICTURE) A. bilateral exophthalamus b. large visible goiter c. myxedema d. moon face
b
The nurse is providing instructions to a patient who is taking the antithyroid medication propylthiouracil (PTU). The nurse instructs the patient to notify the health care provider immediately if which sign/symptom occurs? A. Weight gain b. Dark-colored urine c. Cold intolerance d. Headache
b
What is the hallmark of thyroid cancer? A. aggressive tumors b. Elevated serum thyroglobulin level c. Metastasis to other organs d. Invasion of blood vessels
b
Which are preoperative instructions for a patient having thyroid surgery? (SATA) a. Teach postoperative restrictions such as no coughing and deep-breathing exercises to prevent strain on the suture line b. Teach the moving and turning technique of manually supporting the head and avoiding neck extension to minimize strain on the suture line c. Inform the patient that hoarseness for a few days after surgery is usually the result of a breathing tube (endotracheal tube) used during surgery d. Humidification of air may be helpful to promote expectoration of secretions. Suctioning may also be used e. Clarify any questions regarding placement of incision, complications, and postoperative care f. A supine position and lying flat will be maintained postoperatively to avoid strain on suture line
bcde
Which foods will the nurse instruct a patient with hypoparathyroidism to avoid? (SATA) a. Canned vegetables b. yogurt c. Fresh fruit d. Red meat e. Milk f. Processed cheese
bef
A patient is admitted to the medical unit with possible Graves disease. Which assessment finding supports this diagnosis? A. Perioribital edema B. Bradycardia C. Exophthalmos D. Hoarse voice
c
As the shift begins, you are assigned to care for the following patients. Which patient should you assess first? A. 38 yo with Graves disease and HR of 94 B. 63 yo with T2DM and fingerstick glucose level of 137 C. 58 yo with hypothyroidism and a HR of 48 D. 49 yo with Cushing disease and dependent edema rated as 1+
c
The patient with hyperparathyroidism who is not a candidate for surgery asks you why she is receiving IV normal saline and IV furosemide. What is your best response?1. "This therapy is to protect your kidney function."2. "You are receiving these therapies to prevent edema formation."3. "Diuretic and hydration therapies are used to reduce your serum calcium."4. "These therapies may help to improve your candidacy for surgery."
c
Which statement best describes globe lag in a patient with hyperthyroidism? A. Abnormal protrusion of the eyes b. Upper eyelid fails to descend when the patient gazes downward c. Upper eyelid pulls back faster than the eyeball when the patient gazes upward d. Inability of both eyes to focus on an object simultaneously
c
After a thyroidectomy, a patient reports tingling around the mouth and muscle twitching. Which complication do these assessment findings indicate to the nurse? A. hemorrhage b. Respiratory distress c. Thyroid storm d. hypocalcemia
d
Laboratory findings of elevated T# and T4, decreased TSH, and high thyrotropin receptor antibody titer indicate which condition? A. Multinodular goiter b. Hyperthyroidism related to overmedication c. Pituitary tumor suppressing TSH d. Graves' disease
d
The nurse assessing a patient palpates enlargement of the thyroid gland, along with noticeable swelling of the neck. How does the nurse interpret this finding? A. globe lag b. Myxedema c. Exophthalmos d. Goiter
d
The nurse is caring for a young female patient with papillary carcinoma of the thyroid gland. Which treatment is mist likely to be prescribed for this patient? a. radiation therapy b. ablation c. chemotherapy d. thyroidectomy
d
The nurse is performing a physical examination of a patient's thyroid gland. Precautions are takin in performing the correct technique because palpation can result in which occurrence? A. Damage to the esophagus causing gastric reflux b. Obstruction of the carotid arteries causing a stroke c. Pressure on the trachea and laryngeal nerve causing hoarseness d. Exacerbation of symptoms by releasing additional thyroid hormone
d
What is the most common cause of death from myxedema coma? A myocardial infarction b. Acute kidney failure c. High serum level of iodide d. Respiratory failure
d
You are instructing a senior nursing student on the techniques for palpation of the thyroid gland. What precaution would you be sure to include when instructing the student about thyroid palpation?1. Always stand to the side of the patient.2. Instruct the patient not to swallow.3. Palpate using one hand and then the other.4. Always palpate the thyroid gland gently
d
