Thyroid & Parathyroid

Which of the following equipment will the nurse place in the patient's room for a patient returning following a thyroidectomy? a. A tracheostomy tray b. Padded tongue blades c. A closed chest drainage system d. A prefilled syringe of 50% glucose

a. A tracheostomy tray

A nurse assessing a patient with hypothyroidism is completing the PSYCHOSOCIAL part of the assessment. Which question should be included? a. Have you been experiencing changes in your mood? b. How are you sleeping at night? c. Are you taking your thyroid medication on an empty stomach? d. Have you noticed any changes in your weight?

a. Have you been experiencing changes in your mood?

The nurse asks the patient to state his name following a thyroidectomy. What is the nurse assessing by this action? a. Laryngeal nerve damage b. Level of consciousness c. Post-op bleeding d. Trigeminal nerve damage

a. Laryngeal nerve damage

Which of the following signs and symptoms causes concern and requires nursing intervention for a patient who recently had a thyroidectomy? a. P 120, BP 220/102, T 103.2 b. P 35, BP 60/43, T 95.3 c. Soft hair, irritable, diarrhea d. Constipation, drowsiness, goiter

a. P 120, BP 220/102, T 103.2

A patient comes to the clinic because she has experienced a weight loss of 20 pounds over the last month, even though her appetite has been "ravenous" and she hasn't changed her activity level. She's diagnosed with Grave's disease. For which other signs and symptoms of Grave's disease should the nurse assess the patient? (Select all that apply) a. Rapid, bounding pulse b. Bradycardia c. Heat intolerance d. Mild tremors e. Nervousness f. Constipation

a. Rapid, bounding pulse c. Heat intolerance d. Mild tremors e. Nervousness

The nurse is assessing a patient after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany b. Hemorrhage c. Thyroid storm d. Laryngeal nerve damage

a. Tetany

Which of the following medications should be available to provide emergency treatment if a patient develops tetany after a subtotal thyroidectomy? a. Sodium phosphate b. Calcium gluconate c. Echothiophate iodide d. Sodium bicarbonate

b. Calcium gluconate

Which information in a patient's history represents a contraindication to the use of radioactive iodine? a. Presence of a goiter b. Shellfish allergy c. Use of a salt substitute d. Anticoagulant therapy

b. Shellfish allergy

The nurse has put in a consult with the hospital's dietician to teach the patient about their prescribed diet. The patient has been diagnoses with hyperparathyroidism and is to follow a diet that is high in Vit D and Ca and low in phosphorus. Which part of QSEN does this represent? a. Patient centered care b. Teamwork and collaboration c. Safety d. Evidence-based practice

b. Teamwork and collaboration

1. A patient recently diagnosed with hypothyroidism demonstrates understanding of prescribed levothyroxine medication when she makes which statement? a. "I should be able to become pregnant in a couple of months." b. "This medication will help me lose all this excess weight." c. "I should call the physician for nervousness, diarrhea, or increased pulse." d. "This medication should be taken with food, preferably dairy products."

c. "I should call the physician for nervousness, diarrhea, or increased pulse."

The nurse is administering a saturated solution of potassium iodide. The nurse should do which of the following? a. Pour the solution over ice chips and have patient sit up to drink b. Mix the solution with an antacid to decrease GI irritation c. Dilute with water, milk, or fruit juice and have the patient drink with a straw d. Disguise the solution in a pureed fruit or vegetable or applesauce

c. Dilute with water, milk, or fruit juice and have the patient drink with a straw

1. A female patient newly diagnosed with hypothyroidism indicates that she no longer participates in evening social activities stating, "There is too much walking, and I prefer to go to bed early. I see enough of my friends at work every day." The nurse formulates which priority nursing diagnosis for this patient?" a. Social isolation related to sleep rest needs as evidenced by desire to go to bed early b. Disturbed sleep pattern related to excessive work as evidenced by desire to go to bed early and avoid evening activities c. Fatigue related to reduced metabolic rate as evidence by desire to avoid evening activities after work d. Decreased cardiac output related to weak myocardium as evidenced by desire to avoid walking

c. Fatigue related to reduced metabolic rate as evidence by desire to avoid evening activities after work

When lifting the patient with hyperparathyroidism, the nurse aide uses a lift sheet. Which part of QSEN does this represent? a. Patient centered care b. Teamwork and collaboration c. Safety d. Evidence-based practice

c. Safety

What additional assessment technique should the nurse perform to assess for hypocalcemia? a. Assess for Battle's sign b. Elicit a Babinski reflex c. Perform an Allen's test d. Assess for Chvostek's sign

d. Assess for Chvostek's sign

A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms Do Not present with this condition? a. Weight loss b. Intolerance to heat c. Smooth skin d. Hair loss

d. Hair loss

Which nursing diagnosis takes highest priority for a female patient with hyperthyroidism? a. Risk for imbalanced nutrition: more than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

A patient is speaking in a whispery voice following a thyroidectomy. What does this indicate? a. Thyroid has not been completely removed. b. Hemorrhaging at the internal incision site. c. Metastatic thyroid cancer. d. Laryngeal nerve damage.

d. Laryngeal nerve damage.

The hormone that increases calcium resorption form the bones and kidney and increases absorption for the intestines is which of the following? a. Thyroid stimulating hormone b. Calcitonin c. Aldosterone d. Parathyroid hormone

d. Parathyroid hormone

The patient in a thyroid storm had the below vital signs. Which one indicates the need to call the physician? 1115 - BP 110/76, P 74, R 16, T 98.2 1345 - BP 128/84, P 88, R 20, T 99.6 a. Blood pressure b. Heart rate c. Respirations d. Temperature

d. Temperature

A patient is being educated on how to take their anti-thyroid medication. Which of the following statements indicates the need for further education? a. "I will continue taking aspirin daily." b. "I will take this medication at the same time every day." c. "It may take a while before I notice that the medication is helping my condition." d. "I will avoid foods containing high levels of iodine."

a. "I will continue taking aspirin daily."

Following a thyroidectomy, the patient develops hypoparathyroidism. The nurse teaches the patient that maintenance therapy for the hypoparathyroidism will include which of the following? a. Calcium supplements b. Diet high in oxalic acid c. Phosphorous supplements d. Parental parathyroid hormone

a. Calcium supplements

A patient receiving a TSH stimulation test showed no increase in their TSH level after 30 minutes. Which statement best describes this phenomenon? a. This is indicative of hyperthyroidism b. The patient's prednisone needs to be increased c. This is used to diagnose hypoparathyroidism d. This is a normal finding for a 38-year-old female

a. This is indicative of hyperthyroidism

The nurse is reviewing the patient's triiodothyronine and notices that it is elevated. Which statement by the nurse would be most accurate? a. "The patient's TSH is elevated." b. "The patient's T3 is elevated." c. "The patient's calcitonin is elevated." d. "The patient's T4is elevated."

b. "The patient's T3 is elevated."

Which assessment finding would indicate the possible onset of thyroid storm? a. Numbness and tingling in both arms b. Tachycardia, fever, and altered mental state c. Pain and a hoarse voice d. Respiratory stridor

b. Tachycardia, fever, and altered mental state

A patient arrives in the clinic with a possible parathyroid hormone deficiency. Diagnosis of this condition includes the analysis of serum electrolytes. Which of the following electrolytes would the nurse expect to be abnormal? (Select all that apply) a. Sodium b. Potassium c. Calcium d. Chloride e. Phosphorus

c. Calcium e. Phosphorus

The additional assessment for hypocalcemia is positive. Which nursing action should be implemented immediately? a. Set the defibrillator for 200 joules b. Place patient in a shock position c. Confirm that a tracheostomy set, suction, and O2 are available at bedside d. Reduce patient's IV rate to keep open rate at 20 ml/hr

c. Confirm that a tracheostomy set, suction, and O2 are available at bedside

1. When instructing the female patient diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following? a. Restricting fluids b. Restricting sodium c. Forcing fluids d. Restricting potassium

c. Forcing fluids

The nurse is caring for a patient who has just been diagnosed with Graves' disease. During patient education, the nurse should include what information? a. Atropine-like medications are safe to use b. Thyroid hormone replacement therapy is necessary c. A low-calorie diet will be ordered d. Propylthiouracil (PTU) will be prescribed

d. Propylthiouracil (PTU) will be prescribed

You are performing discharge teaching with a patient who is going home on levothyroxine. Which statement by the patient indicates the need for further education? a. "I will take this medication at bedtime with a snack." b. "I will never stop taking the medication abruptly." c. "If I have palpitations, chest pain, or intolerance to heat, I will notify the doctor." d. "I will not take this medication at the same time I take my Carafate."

a. "I will take this medication at bedtime with a snack."

The unlicensed assistive personal (UAP) reports to the nurse that the 6 hour post-op patient is upset because there is blood on the patient's gown. What is the priority action of the nurse? a. Assess the patient's breath sounds and respiratory effort b. State it is normal and ask the UAP to change the gown c. Asses the patient's pain and reassure that some bleeding is normal d. Reinforce the dressing, change the gown, and call the surgeon

a. Assess the patient's breath sounds and respiratory effort

The nurse would expect to administer which medication to treat a patient's hypocalcemia? a. Calcium gluconate b. Calcitonin c. Calcitriol d. Pilcamycin

a. Calcium gluconate

The nurse is reviewing a patient's medication record and notes that levothyroxine is ordered. The nurse is aware this drug may be used for a variety of conditions, including which of the following? (Select all that apply) a. Cretinism b. Thyroid cancer c. Myexedema coma d. Adrenal insufficiency e. Type 2 diabetes mellitus

a. Cretinism b. Thyroid cancer c. Myexedema coma

A female patient has been taking propylithiouracil for 5 months to treat hyperthyroidism. After falling and spraining her ankle, she is treated and is given crutch-walking instructions. She says she will never have enough energy to get around on crutches and is upset about the 10 pounds she gained this winter. What should be the nurse's first action? a. Document the patient's statements and consult the doctor to order the serum T4 b. Discharge the patient home and encourage her to have a TSH level drawn c. Encourage the patient to rest at home until the sprain is healed, then increase activity d. Investigate the availability of a walking splint instead of using the crutches

a. Document the patient's statements and consult the doctor to order the serum T4

A patient is to be discharged home after stabilization of fluid and electrolyte levels. Which are critical concepts that the nurse should teach the patient prior to discharge? (Select all that apply) a. Importance of keeping follow-up appointments for laboratory tests and with doctor b. Strategies that will help decrease the risk of falling c. Significant signs of hypoglycemia to monitor for and report d. Signs and symptoms of renal calculi to monitor for and report e. How to plan meals that include increased amounts of calcium and vitamin D

a. Importance of keeping follow-up appointments for laboratory tests and with doctor b. Strategies that will help decrease the risk of falling e. How to plan meals that include increased amounts of calcium and vitamin D

Detecting an increased levels of thyroid hormone in the body, the pituitary gland is signaled to stop producing TSH. What is this an example of? a. Negative feedback b. Closed circulatory c. Euthyroidism d. Pituithyroid loop

a. Negative feedback

During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. The nurse interprets this finding as which of the following? a. Normal finding b. Evidence of an atrophied thyroid gland c. Insignificant in a patient with elevated T3 and T4 levels d. Abnormal, confirmation of the finding by another experienced health care professional is necessary

a. Normal finding

Which clinical manifestation would indicate the need to administer calcium gluconate following a thyroidectomy? a. Positive Trousseau's sign. b. Negative Chevostek's sign. c. Muscle pain. d. Abdominal pain.

a. Positive Trousseau's sign.

After undergoing a subtotal thyroidectomy, a female patient develops hypothyroidism. The physician prescribes levothyroxine, 25 mcg PO daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism b. Grave's disease c. Thyrotoxicosis d. Euthyroidism

a. Primary hypothyroidism

A patient is being treated for hypothyroidism. Which of the following findings indicate that thyroid replacement therapy has been inadequate? (Select all that apply) a. Prolonged QT interval on electrocardiogram b. Tachycardia c. low body temperature d. Nervousness e. Bradycardia f. Dry mouth

a. Prolonged QT interval on electrocardiogram c. low body temperature e. Bradycardia

A female adult patient with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis Risk for Injury. To complete the nursing diagnosis statement for this patient, which "related-to" phrase should the nurse add? a. Related to bone demineralization resulting in pathologic fractures b. Related to exhaustion secondary to an accelerated metabolic rate c. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces d. Related to tetany secondary to a decreased serum calcium level

a. Related to bone demineralization resulting in pathologic fractures; Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.

Propylthiouracil is prescribed for a patient with Graves' disease. The nurse should teach the patient to immediately report which of the following? a. Sore throat b. Painful, excessive menstruation c. Constipation d. Increased urine output

a. Sore throat

A patient is receiving radioactive iodine treatment for hyperthyroidism. Which of the following should be included in the patient's education about this treatment? a. Taste changes and swollen salivary glands b. Constipation and abdominal cramps c. Excessive thirst and polyuria d. Risk for sunburn and need for protection

a. Taste changes and swollen salivary glands

The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation? a. Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily b. Client with follicular thyroid cancer who has vocal hoarseness and difficulty swallowing c. Client with Graves' disease who is experiencing increasing anxiety and diaphoresis d. Client with hyperparathyroidism who has just arrived on the unit after a parathyroidectomy

a. The client with chronic hypothyroidism and dementia is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN. A client with vocal hoarseness and difficulty swallowing is at higher risk for complications and requires close observation by a more experienced nurse. Increasing anxiety and diaphoresis in a client with Graves' disease can be an indication of impending thyroid storm, which is an emergency; this is not a situation to be managed by a newly graduated RN. A client who has just arrived on the unit after a parathyroidectomy requires close observation for bleeding and airway compromise and requires assessment by an experienced nurse.

Which statement by the patient with Grave's disease indicates that teaching has been effective? a. "I will take my thyroid replacement medication in the morning on an empty stomach." b. "I will use artificial tears eye drops to keep my eyes from becoming too dry." c. "I will need to avoid eating or drinking foods high in protein and calcium, such as milk." d. "I will be able to lose this extra weight as soon as the medication starts to work."

b. "I will use artificial tears eye drops to keep my eyes from becoming too dry."

A patient with thyrotoxicosis says to the nurse, "I am so irritable. I am having problems at work because I lose my temper very easily." Which of the following responses by the nurse would give the patient the most accurate explanation of her behavior? a. "Your behavior is caused by temporary confusion brought on by your illness." b. "Your behavior is caused by the excess thyroid hormone in your system." c. "Your behavior is caused by your worrying about the seriousness of your illness." d. "Your behavior is caused by the stress of trying to manage a career and cope with illness."

b. "Your behavior is caused by the excess thyroid hormone in your system."

A patient with cardiovascular disease has been recently diagnosed with hypothyroidism, and levothyroxine has been prescribed. Which manifestation related to this medication is most important for the patient to report to the physician? a. Increased urine output b. Chest pain c. Increase in appetite d. Loose stools

b. Chest pain

The nurse is assessing a patient diagnosed with hypothyroidism. Which of the following clinical manifestations should the nurse asses the patient for? (Select all that apply) a. Rapid pulse b. Decreased energy and fatigue c. Weight gain of 10 pounds d. Fine, thin hair with hair loss e. Constipation f. Menorrhagia

b. Decreased energy and fatigue c. Weight gain of 10 pounds e. Constipation f. Menorrhagia

Two weeks after a partial thyroidectomy, a patient is being seen for his postoperative follow-up appointment. The nurse is aware that the patient is at increased risk for hypothyroidism. Which signs and symptoms would the nurse expect to find in a patient with hypothyroidism? (Select all that apply) a. Heat intolerance b. Hair loss c. Increased energy d. Dry skin e. Cold intolerance f. Fatigue

b. Hair loss d. Dry skin e. Cold intolerance f. Fatigue

The nurse is caring for a patient who recently was diagnosed with hypoparathyroidism. To determine the effectiveness of medication therapy with calcitrol, the nurse should assess lab findings to see if what change has occurred? a. Potassium levels are holding steady b. Hypocalcemia is resolving c. Hypermagnesemia is resolving d. Vitamin D levels are decreasing

b. Hypocalcemia is resolving

Manifestations of endocrine problems that are commonly attributed solely to aging in the older adults are those involving which of the following? a. Hypogonadism b. Hypothyroidism c. Hypoaldosteronism d. Hypoparathyroidism

b. Hypothyroidism

The thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? (Select all that apply) a. Storing calories b. Increasing the heart rate c. Stimulating the sympathetic nervous system d. Decreasing the body's temperature e. Regulating TSH produced by the anterior pituitary gland

b. Increasing the heart rate c. Stimulating the sympathetic nervous system e. Regulating TSH produced by the anterior pituitary gland

A patient with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide is prescribed preoperatively for the patient. Which of the following is the primary reason for using this drug? a. It helps slow progression of exophthalmos b. It helps reduce the vascularity of the thyroid gland c. It helps decrease the body's ability to store thyroxine d. It helps increase the body's ability to excrete thyroxine

b. It helps reduce the vascularity of the thyroid gland

A patient just diagnosed with hypothyroidism, also takes sodium warfarin. Before giving any thyroid replacement hormone, the nurse should check the results of what lab value? a. Complete blood count b. PT and INR c. Activated partial thromboplastin time d. Warfarin level

b. PT and INR

The nurse would anticipate a patient with hypothyroidism to experience which clinical manifestations? a. Increased appetite and weight loss b. Puffiness of the face and hands c. Nervousness and tremors d. Thyroid gland swelling

b. Puffiness of the face and hands; Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

The nurse is completing a health assessment of a 42-year-old female with suspected Grave's disease. The nurse should assess the patient for which clinical manifestation? a. Anorexia b. Tachycardia c. Weight gain d. Cold skin

b. Tachycardia

A patient is being discharged after having a thyroidectomy. Which of the following discharge instructions would be appropriate for this client? (Select all that apply) a. Report signs and symptoms of hypoglycemia b. Take thyroid replacement medication as ordered c. Watch for changes in body functioning, such as lethargy, restlessness, and dry skin and report these changes to the physician d. Avoid all over-the-counter medications e. Carry injectable dexamethasone at all times

b. Take thyroid replacement medication as ordered c. Watch for changes in body functioning, such as lethargy, restlessness, and dry skin and report these changes to the physician

A patient has been ordered both thionamide and sodium iodide. How should these medications be given? a. Together in the morning, with or with food. b. The sodium iodide should be given one hour after the thionamide. c. The doctor should be called to clarify the order. d. The thiomide should be given in the morning and the sodium iodide at night.

b. The sodium iodide should be given one hour after the thionamide.

Early this morning, a female patient had a subtotal thyroidectomy. During evening rounds, the nurse assess the patient, who now has nausea, a temperature of 105 degrees, tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany

b. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

Which of the following symptoms might indicate that a patient was developing tetany after a subtotal thyroidectomy? a. Pains in the joints of the hands and feet b. Tingling in the fingers c. Bleeding on the back of the dressing d. Tension on the suture line

b. Tingling in the fingers

A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the patient for which of the following? a. Tachycardia b. Weight gain c. Diarrhea d. Nausea

b. Weight gain

During an assessment of a patient, which question by the nurse specifically addresses thyroid function? a. "Do you have to get up numerous times during the night to urinate?" b. "Have you experienced any blurring or double vision while driving at night?" c. "Do you experience fatigue even if you have slept a long time?" d. "Can you describe the amount of stress you have at home and work?"

c. "Do you experience fatigue even if you have slept a long time?"

A patient with hyperthyroidism is hospitalized to have a thyroidectomy. The physician has prescribed propranolol. In reviewing the patient's history, the nurse notes that the patient has asthma. Which action should the nurse take next? a. Take the patient's pulse and hold the propranolol if the pulse is less than 100 beats per minute b. Count the patient's respirations and hold the propranolol if the respirations are less than 20 beats per minute c. Contact the physician, question the order for propranolol with the patient's asthma history d. Instruct the patient to make position changes slowly

c. Contact the physician, question the order for propranolol with the patient's asthma history

When teaching a patient newly diagnosed with Graves' disease about this disorder, the nurse would explain this is related to which of the following? a. A viral infection of the thyroid gland that causes overproduction of thyroid hormones b. A chronic autoimmune process in which thyroid tissue is replaced by lymphocytes and fibrous tissue c. Development of thyroid-stimulating antibodies that cause growth and overproduction of the thyroid gland d. Ingestion of goitrogens, or foods and drugs that inhibit synthesis of thyroid hormone, causing an increase in the size of the thyroid gland

c. Development of thyroid-stimulating antibodies that cause growth and overproduction of the thyroid gland

A patient is admitted with complaints of palpitations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? a. Thyroiditis b. Deficiency of iodine consumption c. Grave's disease d. Hypothyroidism

c. Grave's disease

A patient presents with an increase in T3 and T4 and a decrease in TST. Which endocrine disorder correlates with these lab results? a. Thyroiditis. b. Hypoparathyroidism. c. Grave's disease. d. Addisonian crisis.

c. Grave's disease.

An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)? a. Ask the client about any numbness or tingling. b. Check for bone deformities in the client's back. c. Measure the client's intake and output hourly. d. Monitor the client for shortness of breath.

c. Measuring intake and output is a commonly delegated nursing action that is within the UAP scope of practice. Numbness and tingling is part of the client assessment that needs to be completed by a licensed nurse. Bony deformities can be due to pathologic fractures; physical assessment is a complex task that cannot be delegated. An older client receiving an IV at 150 mL/hr is at risk for congestive heart failure; careful monitoring for shortness of breath is the responsibility of the RN.

An incoherent female patient with a history of hypothyroidism is brought to the ER by the rescue squad. Physical and lab findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and non-pitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of which of the following? a. Thyroid storm b. Cretinism c. Myxedema coma d. Hashimoto's thyroiditis

c. Myxedema coma; Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

A patient who takes levothyroxine had a cholecystectomy yesterday. Laboratory results indicate a normal T4 level and a decreased TSH level. Which action should the nurse take? a. Hold the medication and notify the physician of the lab results b. Explain to the patient that the medication is not needed after surgery c. Schedule the medication for early each morning to mimic normal thyroid release d. Teach the patient about the manifestations of hyperparathyroidism following surgery

c. Schedule the medication for early each morning to mimic normal thyroid release

A patient with a history of cardiac disease is exhibiting severe symptoms of hypothyroidism, and is started on medication therapy with levothyroxine. The nurse anticipates that which principle will be followed for initiation of drug therapy? a. Start with highest dose, and titrate according to the patient's response b. Start with the highest dose and give a beta blocker to prevent tachycardia c. Start with a low dose and gradually increase the dose over a period of weeks d. Administer a fixed dose calculated patient's weight; adjust as necessary

c. Start with a low dose and gradually increase the dose over a period of weeks

In teaching a patient with hypoparathyroidism about the disorder, the nurse explains that blood calcium levels are altered because the role of parathyroid hormone is which of the following: a. Promote magnesium excretion by the kidney, which raises blood calcium levels b. Stimulate the cells of the GI tract to absorb dietary calcium, raising the blood level c. Stimulate bone resorption and increase the calcium in the blood when blood calcium levels fall d. Block phosphorus excretion by the kidneys, which decreases the blood calcium level because calcium and phosphorus are reciprocal

c. Stimulate bone resorption and increase the calcium in the blood when blood calcium levels fall

A female patient with hypothyroidism is receiving levothyroxine, 25 mcg PO daily. Which finding should the nurse recognize as an adverse effect of this drug? a. Dysuria b. Leg cramps c. Tachycardia d. Blurred vision

c. Tachycardia; Levothyroxine a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren't associated with levothyroxine.

The patient diagnosed with hypothyroidism reports that they have been compliant with their medications and does not have any complaints other than they have started experiencing hand tremors. How should the nurse interpret this finding? a. The patient has not been taking the medication as prescribed. b. The patient is not taking their medications on an empty stomach. c. The patient may need a decrease in their dose of thyroid medication. d. The patient is developing an intolerance to their thyroid medication.

c. The patient may need a decrease in their dose of thyroid medication.

A patient with Grave's disease is treated with radioactive iodine in the form of sodium iodide 131. Which of the following statements by the nurse will explain to the patient how the drug works? a. "The radioactive iodine stabilizes the thyroid hormone levels before a thyroidectomy." b. "The radioactive iodine reduces uptake of thyroxine and thereby improves your condition." c. "The radioactive iodine lowers the levels of thyroid hormones by slowing your body's production of them." d. "The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced."

d. "The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced."

During preoperative teaching for a female patient who will undergo subtotal thyroidectomy, the nurse should include which statement? a. "The head of your bed must remain flat for 24 hours after surgery." b. "You should avoid deep breathing and coughing after surgery." c. "You won't be able to swallow for the first day or two." d. "You must avoid hyperextending your neck after surgery."

d. "You must avoid hyperextending your neck after surgery."; To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

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. 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. Clients with Hashimoto's thyroiditis are usually stable; this client does not need to be assessed first. Although an apical pulse of 51 is considered bradycardia, a low heart rate is a symptom of hypothyroidism. A client with a kidney stone will be uncomfortable and should be asked about pain medication as soon as possible, but this client does not need to be assessed first.

A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine prior to surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively for which of the following? a. Eliminate the risk for postoperatively tetany b. Decrease the risk of hypometabolism during and after surgery c. Assist in locating the thyroid and parathyroid glands during surgery d. Decrease the size and vascularity of the gland, making resection easier and safer

d. Decrease the size and vascularity of the gland, making resection easier and safer

Serum concentrations of thyroid hormones and TSH are tests ordered for the patient with thyrotoxicosis. Which of the following lab values are indicative of thyrotoxicosis? a. Elevated thyroid hormone concentrations and normal TSH b. Elevated TSH and normal thyroid hormone concentrations c. Decreased thyroid hormone concentrations and elevated TSH d. Elevated thyroid hormone concentrations and decreased TSH

d. Elevated thyroid hormone concentrations and decreased TSH

Which nursing intervention is appropriate for a patient receiving radioactive iodine therapy? a. Assess for respiratory stridor b. Monitor the patient's voice for hoarseness c. Instruct the patient to avoid hyperextension of the neck d. Encourage the patient to drink plenty of fluids

d. Encourage the patient to drink plenty of fluids

A 67-year-old female patient has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders? a. Thyroid storm b. Hypopotassium c. Hypoparathyroidism d. Hyperparathyroidism

d. Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria.

What effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client? 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 are possible if the levothyroxine sodium dose is started too high or raised too rapidly, because levothyroxine would essentially put the client into a hyperthyroid state. The client would be tachycardic, not bradycardic. The client may have an increased respiratory rate. Shock may develop, but only as a late effect and as the result of "pump failure."

A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? a. Pheochromocytoma b. Hyperthyroidism c. Thyroid storm d. Hypothyroidism

d. Hypothyroidism

Before the procedure, the patient should be informed of which possible long-term side effect of radioactive iodine? a. Thyroiditis b. Thyroid nodules c. Thyroid storm d. Hypothyroidism

d. Hypothyroidism

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops which of the following? a. Muscle weakness and weight loss b. Hyperthermia and severe tachycardia c. Hypertension and difficulty swallowing d. Laryngospasm and tingling in the hands and feet

d. Laryngospasm and tingling in the hands and feet

A recently retired patient who lives alone is admitted with myxedema coma, which occurred because of inability to pay for the medication. What is the highest priority of the nurse at the time of admission? a. Assist the patient to chair every 4 hours to promote oxygenation and prevent skin breakdown b. Prevent injury related to mental confusion and elevated blood pressure c. Prevent skin breakdown and promote nutrition with low-fiber foods d. Monitor for signs of decreased cardiac output and airway obstruction

d. Monitor for signs of decreased cardiac output and airway obstruction

A patient with hyperparathyroidism is admitted with cardiac dysrhythmias, including bursts of supraventricular tachycardia (SVT) and occasional premature ventricular contractions (PVCs). The patient asks why the cardiologist prescribed so much IV fluid and then furosemide. What is the nurse's best explanation? a. Improve cardiac output b. Eliminate metabolic waste c. Replace missing electrolytes d. Promote excretion of calcium

d. Promote excretion of calcium

The nurse is caring for a patient who has just been diagnosed with Grave's disease. During patient education, the nurse should include what information? a. Atropine-like medications are safe to use b. Thyroid hormone replacement therapy is necessary c. A low-calorie diet will be ordered d. Propylthiouracil will be prescribed

d. Propylthiouracil will be prescribed

A patient is 6 hours post-op from a thyroidectomy. The surgical site is clean, dry, and intact with no excessive swelling noted. What position is best for this patient to be in? a. Fowler's b. Prone c. Trendelenburg d. Semi-fowler's

d. Semi-fowler's

A patient with Grave's disease has been taking medication therapy as prescribed. Which finding, noted on cardiac assessment indicates to the nurse that the patient has not had a sufficient response to medication therapy? a. Decreased systolic blood pressure b. Narrowed pulse pressure c. Bradycardia d. Tachycardia

d. Tachycardia

A patient with hyperthyroidism is taking potassium iodide prior to having a thyroidectomy. The nurse instructs the patient to do which of the following? a. Discontinue all other medications b. Take on an empty stomach c. Take with a full glass of milk d. Take with a meal or snack

d. Take with a meal or snack

1. A 82-year old male patient experiencing a thyroid storm is having restlessness, confusion, psychosis, and seizures. The patient's daughter states that she wants everything done to prevent her father from dying. The patient has an advance directive stating that he wishes no life support measures. The patient is widowed, making the daughter next of kin. Which of the following statements is true about this situation? a. The daughter has the right to make decisions regarding life support for her father. b. The daughter has not right to make any medical decisions for her father. c. The patient should be asked to clarify his medical wishes. d. The patient's advance directive takes priority over the daughter's wishes.

d. The patient's advance directive takes priority over the daughter's wishes.

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 nurse in a provider's office is reviewing the health record of a client who is being evaluated for Grave's disease. The nurse should identify that which of the following lab results is an expected finding? A. decreased thyrotropin receptor antibodies B. decreased TSH C. decreased free thyroxine index D. decreased triiodothyronine

B. decreased TSH Rationale:in the presence of Grave's disease, low TSH is an expected finding. The pituitary gland decreased the production of TSH when thyroid hormone levels are elevated

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (SATA) A. anorexia B. heat intolerance C. constipation D. palpitations E. weight loss F. bradycardia

B. heat intolerance D. palpitations E. weight loss

A patient has a total serum calcium level of 3 mm/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal which of the following? a. Decreased serum PTH b. Increased serum ACTH c. Increased serum glucose d. Decreased serum cortisol levels

a. Decreased serum PTH

A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone? a. Furosemide b. Levothyroxine c. Proton pump inhibitor d. Antacid

a. Furosemide

Which disease is the most common type of hyperthyroidism? a. Graves disease b. Hashimoto's disease c. Cushing's syndrome d. Addison's disease

a. Graves disease

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. a.) Polyuria b.) HA c.) Bone pain d.) Nervousness e.) Weight gain

A & C RATIONALE:The role of parathyroid hormone (PTH) in the body is to maintain serum Ca++ homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (Ca++ is pulled from the bones). Hypercalcemia occurs w/hyperparathyroidism. Elevated serum Ca++ levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of Ca++ from the bones causes bone pain.

The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimoto's thyroiditis. 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 the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

A client has been diagnosed with hyperthyroidism. The nurse monitors for which signs and symptoms indicating a complication of this disorder? Select all that apply. a.) Fever b.) Nausea c.) Lethargy d.) Tremors e.) Confusion f.) Bradycardia

A, B, D, & E RATIONALE;Thyroid storm is an acute & life-threatening complication that occurs in a pt w/uncontrolled hyperthyroidism. Signs & sx's of thyroid storm include elevated temp (fever), nausea, and tremors. In addition, as the condition progresses, the pt becomes confused. The pt is restles and anxious & experiences tachycardia

A husband of a client with graves' disease expresses concern regarding his wife's health because during the past 3 months she has been experiencing nervousness, inability to concentrate even on trivial tasks, and outbursts of temper. On the basis of this information, which nursing diagnosis would the nurse identify as appropriate for the client? a) ineffective coping b) disturbed sensory perception c) social isolation d) grieving

A- Frequently, family and friends may report that the client with Graves' disease has become more irritable or depressed.

In educating a client, the nurse is likely to explain the following is the cause of Hashimoto's disease: A. Antibodies attacking the thyroid gland B. Inflammation in the kidneys C. An adenocarcinoma in the brain D. Overactivation of the pituitary gland

A. Hashimoto's disease is caused by autoimmunity to the thyroid gland, often involving antibodies.

A nurse is monitoring a client's status 24hr after a total thyroidectomy. Which of the following findings should the nurse report to the provider? A. Laryngeal Stridor. B. Productive cough C. Pain with hyperextension of the neck. D. Hoarse, weak voice

A. Laryngeal Stridor.

A nurse is developing a teaching plan for a client who had a thyroidectomy and takes a thyroid hormone replacement (Synthroid). Which of the following instructions should the nurse plan to include? A. Take this med on an empty stomach B. Take this med with an antacid C. Change position slowly while taking this med D. Limit your fluid intake while taking this med

A. Take this med on an empty stomach

An indication of Chvostek' sign is: A. Twitching of the lips after tapping the face B. Elevated blood sugar after glucose infusion C. Inability to hold one's arms straight D. Spasms of the hand after blood circulation is cut off

A. Twitching of the lips after tapping the face; Spasms of the hand are associated with Trousseau's sign.

A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of medication? A. hand tremors B. bradycardia C. pallor D. slow speech

A. hand tremors

Hashimoto's disease is: a. Chronic inflammation of the thyroid gland b. Diagnosed most frequently in Asian-Americans and Pacific Islanders c. A form of hyperthyroidism d. A rare form of hypothyroidism

A: Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.

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) Administering beta blockers to reduce heart rate D) Applying interventions to reduce the patient's temperature

A nurse is providing instructions to a client who has Grave's disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "an adverse effect of this medication is jaundice" B. "take your pulse before each dose" C. "the purpose of this medication is to decrease production of thyroid hormone" D. "you should stop taking this medication if you have a sore throat"

B. "take your pulse before each dose"

Which vitamin is directly involved in the metabolism of the hormones secreted by the parathyroid? A. Vitamin C B. Vitamin D C. Vitamin K D. Vitamin B6

B. Vitamin D; Vitamin D is related to absorption of calcium and phosphorus.

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) Hypophosphatemia C) Hypocalcemia D) Hypokalemia

C) Hypocalcemia

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

A nurse is monitoring a client for complications following thyroidectomy. The nurse notes that the client's voice is very hoarse, and the client is concerned about the hoarseness and asks the nurse about it. The nurse makes which response to alleviate the client's concern? a) hoarseness and weak voice indicate permanent damage to the nerves b) this complication is expected c) this problem is temporary and will probably subside in a few days d) it is best that you not talk at all until the problem is further evaluated

C. Temporary hoarseness and a weak voice may occur if there has been unilateral injury to the laryngeal nerve during surgery. If hoarseness or a weak voice is present, the client is reassured that the problem will probably subside in a few days. Unnecessary talking is discouraged to minimize hoarseness.

A nurse is admitting a client who has hyperthyroidism. When assessing the client, the nurse should expect which of the following findings? A. Cold intolerance B. Lethargy C. Tremors D. Sunken eyes

C. Tremors

A nurse is caring for a client who is taking propylthiouracil (PTU). The nurse should recognize that the client has met the treatment goals when she reports an increase in which of the following effects? A. Sweating B. Stools C. Weight D. Appetite

C. Weight

A health care professional is caring for a patient who is about to begin taking radioactive iodine -131 (Iodotope) to treat Graves' disease. Which of the following instructions should the health care professional include when talking with the patient about the drug?

Expect full effects in 2 to 3 months

A nurse is assessing a client who is 12 hr postop following a thyroidectomy. The nurse should identify which of the following findings as indicative of thyroid crisis? (SATA) A. bradycardia B. hypothermia C. dyspnea D. abdominal pain E. mental confusion

C. dyspnea D. abdominal pain E. mental confusion

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) A fluoroquinalone antibiotic B) A loop diuretic C) A proton pump inhibitor (PPI) D) A benzodiazepine

D) A 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.

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.

A home health nurse is assessing a client who is on lifelong hormone replacement therapy for treatment of hypothyroidism. The client has not been taking meds regularly, Which of the following findings should the nurse expect? A. Increased urine output B. Persistant diarrhea C. Tachycardia D. Hypotension

D. Hypotension

A client with Graves' disease experiences a thyroid storm and has tachycardia and hypertension. What medication is most likely to be used? A. Levofloxcin B. Chlorothiazide C. Percocet D. Propylthiouracil

D. Propylthiouracil

A health care professional is caring for a patient who is about to begin levthyroxine (Synthroid) therapy to treat hypothyroidism. Which of the following instructions should the health care professional include when talking with the patient about taking the drug.

Expect a long life therapy with this drug

A health care professional is caring for a patient who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The health care professional should tell the patient to report which of the following adverse effects?

Sore throat, Muscle pain, Bradycardia, Rash

Parathyroid hormone (PTH) has which effects on the kidney?

Stimulation of calcium reabsorption and phosphate excretion

A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? SATA a. diarrhea b. menorrhagia c. dry skin d. increased libido e. hoarseness

b. menorrhagia c. dry skin e. hoarseness

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? a. Assess the wound dressing for bleeding. b. Give morphine sulfate 4 to 8 mg IV for pain. c. Monitor oxygen saturation using pulse oximetry. d. Support the head and neck with sandbags.

c. Airway assessment and management is always the first priority with every client. This is especially important for a client who has had surgery that involves potential bleeding and edema near the trachea. Assessing the wound dressing for bleeding is a high priority, although this is not the first priority. Pain control and supporting the head and neck with sandbags are important priorities, but can be addressed after airway assessment.

Symptoms of Grave's ophthalmopathy include all of the following EXCEPT: a. Bulging eyeballs b. Dry, irritated eyes and puffy eyelids c. Cataracts d. Light sensitivity

c. Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes. About one-quarter of persons with Grave's disease develop Grave's ophthalmopathy. The condition is frequently self-limiting, resolving without treatment over the course of a year or two.

A patient's T3 and T4 are decreased. The nurse understands that if the cause of the low thyroid hormone levels is primary hypothyroidism, further diagnostic testing would reveal which of the following? a. Hypoalbuminemia b. Increased I 131 uptake c. Increased TSH levels d. Increased serum iodine levels

c. Increased TSH levels

A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? a. Tapazole b. Propylthiouracil c. Levothyroxine d. Inderal

c. Levothyroxine

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? a.) Hypoglycemia b.) Level of hoarseness c.) Respiratory distress d.) Edema at the surgical site

c.) Respiratory distress Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

What term should the nurse use when documenting the wide-eyed appearance related to Graves disease? a. Pretibial myxedema b. Photophobia c. Exophthalamos d. Goiter

c. Exophthalamos

A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? Select all that apply. 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia

1, 2, 4, 5 Thyroid storm is an acute and life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1.Insomnia 2.Weight loss 3.Bradycardia 4.Constipation 5.Mild heat intolerance

1,2,5 Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client with hyperthyroidism has been given methimazole (Tapazole). Which nursing considerations are associated with this medication? Select all that apply. 1.Administer methimazole with food. 2.Place the client on a low-calorie, low-protein diet. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side/adverse effects such as sore throat, fever, or headaches. 5.Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1,3,4 Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider (HCP) should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

The 68-year-old client diagnosed with hyperthyroidism is being treated with radio active iodine therapy. Which interventions should the nurse discuss with the client? 1. Explain it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach the iodine therapy will have to be tapered slowly over one (1) week. 3. Discuss the client will have to be hospitalized during the radioactive therapy. 4. Inform the client after therapy the client will not have to take any medication.

1.Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the client is followed closely for three (3) to four (4) weeks until the euthyroid state is reached. 2. A single dose of radioactive iodine therapyis administered; the dosage is based on theclient's weight.3. The colorless, tasteless radioiodine is administered by the radiologist, and theclient may have to stay up to two (2) hoursafter the treatment in the office.4. If too much of the thyroid gland is destroyed by the radioactive iodine therapy, the client may develop hypothy-roidism and have to take thyroid hormonethe rest of his or her life

The nurse provides medication instructions to a client who is taking levothyroxine (Synthroid) and should tell the client to notify the health care provider (HCP) if which problem occurs? 1.Fatigue 2.Tremors 3.Cold intolerance 4.Excessively dry skin

2. Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? 1.Myxedema 2.Graves' disease 3.Addison's disease 4.Cushing's syndrome

2. Propylthiouracil (PTU) inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

The client with hyperparathyroidism is taking alendronate (Fosamax). Which statements by the client indicate understanding of the proper way to take this medication? SATA 1. I should take this medication with food. 2. I should take this medication at bedtime. 3. I should sit up for at least 30 minutes after taking this medication. 4. I should take this medication first thing in the morning on an empty stomach. 5. I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day.

3, 4

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching?a.) I should limit my fluids to 1 liter per day b.) I should use my treadmill or go for walks daily c.) I should follow a moderate-calcium, high-fiber diet d.) My alendronate helps to keep calcium from coming out of my bones

A RATIONALE:In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to 2 liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps to protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Clients should follow a moderate-calcium, high-fiber diet. Even though serum calcium is already high, clients should follow a moderate-calcium diet because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

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) A 75-year-old female patient with osteoporosis B) A 50-year-old male patient who is obese C) A 45-year-old female patient who used oral contraceptives D) A 25-year-old male patient who uses recreational drugs

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

A nurse is a provider's office is planning care for a client who has a new diagnosis of Grave's disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the POC? (SATA) A. monitor CBC B. monitor triiodothyronine (t3) C. instruct the client to increase consumption of shellfish D. Advise the client to take the medication at the same time every day E. Inform the client that an adverse effect of this medication is iodine toxicity.

A. monitor CBC B. monitor triiodothyronine (t3) D. Advise the client to take the medication at the same time every day

A nurse in an ICU is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (SATA) A. observe cardiac monitor for dysrhythmias B. observe for evidence of UTI C. initiate IV fluids using 0.9% sodium chloride D. administer levothyroxine IV bolus E. provide warmth using a heating pad

A. observe cardiac monitor for dysrhythmias B. observe for evidence of UTI C. initiate IV fluids using 0.9% sodium chloride D. administer levothyroxine IV bolus

A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? SATA A. weight gain is expected while taking this medication B. medication should not be discontinued without the advice of the provider C. follow up serum TSH levels should be obtained D. take the medication on an empty stomach E. use fiber laxatives for constipation

B. medication should not be discontinued without the advice of the provider C. follow up serum TSH levels should be obtained D. take the medication on an empty stomach

A nurse is caring for a client following thyroidectomy and is monitoring for complications. Which of the following if noted in the client, would indicate a need for physician notification? a) surgical pain in the neck area b) voice hoarseness c) numbness and tingling around the mouth d) weakness of the voice

C- Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or traumatized during surgery. If the client develops numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the physician should be called immediately. A hoarse or weak voice may occur temporarily if there has been unilateral injury to the laryngeal nerve during surgery. Pain is expected in the postoperative period. Calcium gluconate ampules should be available at the bedside, and the client should have a patent intravenous (IV) line in the event that hypocalcemic tetany occurs

A nurse provides dietary instructions to a client with a diagnosis of hyperparathyroidism. Which statement by the client indicates the need for further instructions? a) I need to drink 3000 ml of fluid per day b) I should drink cranberry juice daily c) I should eat foods high in calcium d) I should eat foods high in fiber

C- The client with hyperparathyroidism should consume at least 3000 mL of fluid per day. Measures to prevent dehydration are necessary because dehydration increases serum calcium levels and promotes the formation of renal stones. Cranberry juice and prune juice help make the urine more acidic. A high urinary acidity helps prevent renal stone formation because calcium is more soluble in acidic urine than in alkaline urine. Clients should be on a low-calcium, low-vitamin D diet. High-fiber foods are important to prevent constipation and fecal impaction resulting from the hypercalcemia that occurs with this disorder.

A client is admitted for treatment of hypoparathyroidism. Based on the client's diagnosis, the nurse would anticipate an order for: A. Potassium B. Magnesium C. Calcium D. Iron

C. Calcium

A client presents with hypocalcemia, hyperphosphatemia, muscle cramps, and positive Trosseau's sign. What diagnosis does this support? A. Diabetes insipidus B. Conn's syndrome C. Hypoparathyroidism D. Acromegaly

C. Hypoparathyroidism

All of the following statements about Hashimoto's disease are true except: a. Many patients are entirely asymptomatic b. Not all patients become hypothyroid c. Most cases of obesity are attributable to Hashimoto's disease d. Hypothyroidism may be subclinical

C: Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.

Untreated hyperthyroidism during pregnancy may result in all of the following EXCEPT: a. Premature birth and miscarriage b. Low birthweight c. Autism d. Preeclampsia

C: In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.

What is the treatment for hyperparathyroidism? a. Synthetic thyroid hormone b. Desiccated thyroid hormone c. Surgical removal of the glands d. Calcium and phosphate

C: When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and teeth may lose the minerals needed to remain strong.

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.

Calcium

A clinic nurse is performing an assessment on a client who has hypothyroidism. The nurse would expect to note which clinical manifestation? a) complaints of difficulty sleeping b) complaints of diarrhea c) significant weight loss since the last clinic visit d) complaints of intolerance to cold weather

D- An insufficient level of thyroid hormone causes a decrease in metabolic rate and heat production. Intolerance to cold would be noted. Options A, B and C are clinical manifestations of hyperthyroidism.

A nurse is caring for a client with hypoparathyroidism. In planning for discharge from the hospital, the nurse identifies which of the following as a potential psychosocial nursing diagnosis? a) impaired comfort related to cold intolerance secondary to decreased metabolic rate b) constipation related to decreased peristaltic action secondary to decreased metabolic rate c) high risk for impaired skin integrity related to edema d) anxiety related to the need for lifelong dietary interventions to control the disease

D- Medical management of hypoparathyroidism is aimed at correcting the hypocalcemia. This is accomplished with prescribed medications as well as lifelong compliance to dietary guidelines, which include consumption of foods high in calcium but low in phosphorus. Knowing that the interventions are lifelong can create some anxiety for the client, and this problem needs to be addressed before hospital discharge. The other options are unrelated to this condition and to a psychosocial concern.

A nurse provides instructions to a client who is scheduled for a radioactive iodine uptake test. Which statement by the client indicates a need for further instructions? a) the test measures the rate of iodine uptake by my thyroid gland b) I will need to drink a small dose of radioactive iodine before the test c) a 24 hour urine specimen will need to be collected to measure iodine excretion d) I need to minimize close contact with others in my family for a period of 48 hours after the test because of the radioactivity in my system

D- The client undergoing a radioactive iodine uptake test needs to be reassured that the amount of radioactive iodine used is very small, that it is not harmful to the client, and that the client will not be radioactive. The other options are correct regarding this diagnostic test.

A nurse is caring for a client with hyperthyroidism and is instructing the client about dietary measures. The nurse tells the client that it is important to eat foods that are: a) high in bulk and fiber b) low in calories c) low in carbohydrates and fats d) high in calories

D- The client with hyperthyroidism is usually extremely hungry because of increased metabolism. The client should be instructed to consume a high-calorie diet with six full meals a day. The client should be instructed to eat foods that are nutritious and contain ample amounts of protein, carbohydrates, fats, and minerals. Clients should be discouraged from eating foods that increase peristalsis and thus result in diarrhea, such as highly seasoned, bulky, and fibrous foods.

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test?

Fine-needle biopsy of the thyroid gland. Explanation: Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

A patient who is taking propylthiouracil (PTU) contacts the health care professional to report weight gain, drowsiness, and depression. The health care professional should suspect which of the following adverse reactions to the propylthiouracil?

Hypothyroidism

The nurse provides instructions to a client who is taking levothyroxine (Synthroid). The nurse should tell the client to take the medication at which time? 1.With food 2.At lunchtime 3.On an empty stomach 4.At bedtime with a snack

Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

Before surgery, propranolol is prescribed for a patient with hyperthyroidism. The nurse should assess for which of the following intended outcomes? a. Change in heart rate, reduced anxiety, reduced sweating b. Regrowth of scalp hair, increased tolerance of extreme temperature changes c. Weight gain, improved respiratory status d. Decreased insomnia, decreased restlessness

a. Change in heart rate, reduced anxiety, reduced sweating

The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (Select all that apply.) a. Calcium gluconate b. Emergency tracheotomy kit c. Furosemide (Lasix) d. Hypertonic saline e. Oxygen f. Suction

a, b, e, f. Calcium gluconate should be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema should occlude the airway. Respiratory distress can result from swelling or damage to the laryngeal nerve leading to spasm, so it is important that the nurse work with respiratory therapy to have oxygen ready at the bedside for the client on admission. Because of the potential for increased secretions, it is important that a working suction device is present at the bedside for admission of the client from the operating room. Furosemide might be useful in the postoperative client to assist with urine output; however, this is not of added importance for this client. Hypertonic saline would not be of benefit to this client as the client is not hyponatremic.

The parathyroid glands play a major role in regulating which substances? A. Calcium and Phosphorus B. Cholride and potassium C. Potassium and calcium D. Sodium and potassium

a. Calcium and Phosphorus

A client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? a. "I can return to my job at the nursing home." b. "I must call if my urine is dark." c. "I must faithfully take the drug every 8 hours." d. "I need to report weight gain."

a. The client should avoid large crowds and people who are ill because PTU reduces blood cell counts and the immune response, which increases the risk for infection. The client does not, however, need to remain completely at home. Dark urine may indicate liver toxicity or failure, and the client must notify the provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures better drug action. The client must notify the provider of weight gain because this may indicate hypothyroidism; a lower drug dose may be required.

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse should assess: a. Trousseau's sign. b. Homans' sign. c. Hegar's sign. d. Goodell's sign.

a. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

Which of the following dietary supplements may be ordered for a patient with hypoparathyroidism? a. Vitamin D b. Vitamin K c. Folic Acid d. Magnesium

a. Vitamin D

A nurse is preparing a diet plan for a 50 year old with simple goiter. Which of the following should be included in the clients diet to decrease the enlargement of the thyroid gland? a. iodine b. sodium c. potassium d. calcium

a. iodine

A client recently admitted with hyperparathyroidism has a very high urine output. Of these actions, what does the nurse do next? a. Calls the health care provider b. Monitors intake and output c. Performs an immediate cardiac assessment d. Slows the rate of IV fluids

b. Diuretic and hydration therapies are used most often for reducing serum calcium levels in clients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion. The health care provider does not need to be notified in this situation, given the information available in the question. Cardiac assessment is part of the nurse's routine evaluation of the client. Slowing the rate of IV fluids is contraindicated because the client will become dehydrated due to the use of diuretics to increase kidney excretion of calcium.

A client had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? a. Edema at the surgical site b. Hoarseness c. Pain on moving the head d. Sore throat

b. Hoarseness or stridor is an indication of respiratory distress and requires immediate attention. Edema at the surgical site of any surgery is an expected finding. Pain when the client moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a client has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for clients who have had surgery involving the neck.

A 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. Advise the client to go to a calming environment. b. Ask whether the client has increased cold sensitivity or weight gain. c. Instruct the client to see his health care provider immediately. d. Tell the client to check his pulse again and call back later.

b. Increased sensitivity to cold and weight gain are symptoms of hypothyroidism, indicating an overcorrection by the medication. The client must be assessed further because he may require a lower dose of medication. A calming environment will not have any effect on the client's heart rate. The client will want to notify the health care provider about the change in heart rate. If other symptoms such as chest pain, shortness of breath, or confusion accompany the slower heart rate, then the client should see the health care provider immediately. If the client was concerned enough to call because his heart rate was slower than usual, the nurse needs to stay on the phone with the client while he re-checks his pulse. This time could also be spent providing education about normal ranges for that client.

A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the post-operative period? A. Maintaining fluid and electrolyte balance B. Assessing the client's airway C. Providing needed nutrition and fluids D. Providing pain relief with narcotic analgesics

b. Removal of a goiter can result in laryngeal spasms and airway occlusion.

A client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next? a. Calls the provider b. Encourages the client to rest c. Immediately assesses cardiac status d. Tells the client to slow down

b. The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse should accept the client's behavior and provide a calm, quiet, and comfortable environment. Because the client's behavior is expected, there is no need to call the provider. Monitoring the client's cardiac status is part of the nurse's routine assessment. Telling the client to slow down is unsupportive and unrealistic.

A nurse in a providers office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected? a. elevated T4 b. decreased T3 c. elevated TSH d. decreased cholesterol

b. decreased T3

A client with hypothyroidism is being discharged. Which environmental change may the client experience in the home? a.Frequent home care b. Handrails in the bath c. Increased thermostat setting d. Strict infection-control measures

c. Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary. A client with a diagnosis of hypothyroidism can be safely managed at home with adequate discharge teaching regarding medications and instructions on when to notify the health care provider or home health nurse. In general, hypothyroidism does not cause mobility issues. Activity intolerance and fatigue may be an issue, however. A client with hypothyroidism is not immune-compromised or contagious, so no environmental changes need to be made to the home.

Grave's disease is: a. The most common cause of hypothyroidism b. The most common cause of hyperparathyroidism c. The most common cause of hyperthyroidism d. The most common cause of adrenal insufficiency

c. The most common cause of hyperthyroidism; it is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.

The nurse is teaching a 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. Weight loss indicates a need for a decreased dose, not an increased dose. One of the symptoms of hypothyroidism is lack of energy; thyroid replacement therapy should help the client have more energy. The correct time to take thyroid replacement therapy is in the morning. If the client is gaining weight and continues to feel tired, that is an indication that the dose may need to be increased.

The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? a. bananas b. chicken livers c. milk d. hamburger

c. milk; clients with hyperparathyroidism should use a low-calcium diet

A Clinical Instructor is questioning a student nurse about disorders of the parathyroid glands. Which statement by the nursing student, would indicate the need for further teaching? a. "Hyperparathyroidism results in an increased release of calcium and phosphorus by bones, with resultant bone decalcification." b. "Hyperparathyroidism results in deposits in soft tissues and the formation of renal calculi." c. "Hypoparathyroidism results in impaired renal tubular regulation of calcium and phosphate." d. "Hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the pancreas."

d. "Hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the pancreas." Rationale: Choices a , b, and c are all correct statements. Answer D demonstrates a need for further teaching because hypoparathyroidism results in decreased activation of vitamin D which then results in decreased absorption of calcium by the intestines, not the pancreas.

Which instruction should the nurse include when teaching about the use of PTU? a. "Call the clinic if symptoms do not subside within 24 hours." b. "You will continue taking this medication the rest of your life." c. "Drink this medication with water or fruit juice." d. "Report the onset of a sore throat or fever to your healthcare provider."

d. "Report the onset of a sore throat or fever to your healthcare provider."

A nurse on a surgical floor is caring for a post-operative client who has just had a subtotal thyroidectomy. Which of the following assessments should be completed first on the client? a. Assess for signs of tetany by checking for Chvostek's and Trousseau's signs b. Assess dressing (if present) and the area under the client's neck and shoulders for drainage. c. Administer analgesic pain medications as ordered, and monitor their effectiveness. d. Assess respiratory rate, rhythm, depth, and effort.

d. Assess respiratory rate, rhythm, depth, and effort. All of the above assessments have importance, but airway and breathing in a client should always be addressed first when prioritizing care. Assess for signs of latent tetany due to calcium deficiency, including tingling of toes, fingers, and lips; muscular twitches; positive Chvostek's and Trousseau's signs; and decreased serum calcium levels. However, tetany may occur in 1 to 7 days after thyroidectomy so # 1 is not the highest priority. Assessing for hemorrhage is always important, but the danger of hemorrhage is greatest in the first 12 to 24 hours after surgery, and as this client is immediately post operative it is not the main concern at this time. Pain medication is important but according to Maslow, pain is a psychosocial need to be addressed after a physiologic need.

A client with thyroid cancer has just received 131-Iodine ablative therapy. Which statement by the client indicates a need for further teaching? a. "I cannot share my toothpaste with anyone." b. "I must flush the toilet three times after I use it." c. "I need to wash my clothes separately from everyone else's clothes." d. "I'm ready to hold my newborn grandson now."

d. Clients undergoing 131-Iodine therapy should avoid close contact with pregnant women, infants, and young children for 1 week after treatment. Clients should remain at least 1 meter (39 inches, or roughly 3 feet) away, and limit exposure to less than 1 hour per day. Some radioactivity will remain in the client's salivary glands for up to 1 week after treatment. Care should be taken to avoid exposing others to the saliva. Flushing the toilet three times after use will ensure that all urine has been diluted and removed. Clothing needs to be washed separately and the washing machine then needs to be run empty for a full cycle before it is used to wash the clothing of others.

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response?" a. You should see effects of this medication immediately." b. "You should see effects of this medication within 1 week." c. "You should see full effects from this medication within 1 to 2 days." d. "You should see some effects of this medication within 2 weeks."

d. Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal. Although onset of action is 30 to 40 minutes after an oral dose, the client will not see effects immediately. Effects will take longer than 1 week to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of triiodothyronine (T3) and thyroxine (T4) will be monitored and dosages adjusted as levels fall.

A client is admitted to the hospital with a medical diagnosis of hyperthyroidism. When taking a history which information would be most significant? a. edema, intolerance to cold, lethargy b. peri-orbital edema, lethargy mask like face c. weight loss, intolerance to cold, muscle wasting d. weight loss, intolerance to heat, exophthalmos

d. weight loss, intolerance to heat, exophthalmos