Thyroid - Practice Questions

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use? a. Provide written reminders of self-care information. b. Offer multiple options for management of therapies. c. Ensure privacy for teaching by asking visitors to leave. d. Delay teaching until patient discharge date is confirmed.

A

A patient with hypothyroidism is hypertensive. Which finding indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? A) Elevated thyroxine (T4) level B) Respiratory rate of 16 breaths/minute C) Distant and difficult to hear heart sounds D) Elevated thyroid stimulating hormone level

A

The nurse obtains the following VS's for patient (from previous question): BP: 198/62, Heart Rate: 143 beats/minute, RR 22 breaths/minute. The patient states that she feels like she's going to vomit. Which of the following should the nurse do first? A) Put the patient on a telemetry monitor B) Administer a rapid push of metoprolol C) Prepare ice packs for the patient D) Palpate the patient's thyroid gland

A

Which assessment finding of a client 8 hours after a subtotal thyroidectomy does the nurse consider most relevant as an indication of a possible complication? a) the pt's hand spasm during BP measurement b) the RR has dropped from 18 to 14 breaths/min c) the dressing has a moderate amount of serosanguineous drainage d) the client responds to questions correctly, but does not open the eyes while talking

A

Which finding by the nurse when assessing a patient with Hashimotos thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patients voice b. Apical pulse rate at rest 112 beats/minute c. Elevation in the patients T3 and T4 levels d. Bruit audible bilaterally over the thyroid gland

A

Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed? a) "If I continue to lose weight, I may need an increased dose." b) "I will have more energy with this medication." c) "If I often am constipated and feel tired, I may need an increased dose." d) "I will take the medication every morning."

A

Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism? a) Below normal calcium levels; above normal phosphorus levels b) Below normal calcium levels; below normal phosphorus levels c) Above normal calcium levels; above normal phosphorus levels d) Above normal calcium levels; below normal phosphorus levels

A

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness

B

Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) a) elevated temp b) tachycardia c) somnolence d) elevated SBP e) abd pain/nausea f) slow respiratory rate

A, B, D, E

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information is most important to communicate to the surgeon? a. The patient reports 7/10 incisional pain. b. The patient has increasing neck swelling. c. The patient is sleepy and difficult to arouse. d. The patients cardiac rate is 112 beats/minute.

B

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action is most appropriate? A) Administer the prescribed muscle relaxant. B) Administer ordered IV Calcium Gluconate C) Start the PRN O2 at 2 L/min per cannula. D) Stretch the muscles with passive range of motion.

B

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patients airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.

B

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about which of the following? A) bisphosphonates to reduce bone demineralization. B) calcium supplements to normalize serum calcium levels. C) increasing fluid intake to decrease risk for kidney stones. D) including whole grains in the diet to prevent constipation

B

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? A) Restrict the patient to bed rest. B) Encourage 4000 mL of fluids daily. C) Institute routine seizure precautions. D) Assess for positive Chvostek's sign.

B

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimotos thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addisons disease who takes hydrocortisone twice daily

B

The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says: a. "I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to normal function with the use of thisdrug." d. "I will report any chest pain or difficulty breathing to the doctorright away."

B

Which nursing action will be included in the plan of care for a 55-year-old patient with Graves disease who has exophthalmos? a. Place cold packs on the eyes to relieve pain and swelling. b. Elevate the head of the patients bed to reduce periorbital fluid. c. Apply alternating eye patches to protect the corneas from irritation. d. Teach the patient to blink every few seconds to lubricate the corneas.

B

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? a) "I seem to feel the heat more than other people." b) "I am always tired, even when I get 10 or 12 hours of sleep." c) "Food just doesn't taste good without a lot of salt." d) "My grandmother had thyroid problems."

B

Why is a goiter often present in clients who have Graves disease? a) The low circulating levels of thyroid hormones stimulates the feedback system and triggers the anterior pituitary gland to secrete more thyroid-stimulating hormone, which increases the numbers and size of glandular cells in the thyroid gland. b) The excessive autoantibodies bind to the thyroid-stimulating hormone receptor sites, which increases the number and size of glandular cells in the thyroid gland. c) The autoantibodies stimulate blood vessel growth and blood storage within the thyroid gland, increasing its overall size. d) The autoantibodies stimulate the inflammatory and immune responses to increase the number of white blood cells circulating in the thyroid gland, which increases tissue size without increasing the number of glandular cells.

B

With which client will the nurse be aware of an increased risk for hypoparathyroidism? a) 28-year-old woman with pregnancy-induced HTN b) 35-year-old woman who had radiation therapy for Grave's Disease c) 50-year-old man starting on insulin therapy for T2DM d) 55-year-old man with moderate heart failure after MI

B

Which statements regarding hyperthyroidism are accurate? (Select all that apply.) a) Has a sudden onset of symptoms b) is much more common among women than men c) Produces symptoms of a hypermetabolic state d) most common form is Grave's Disease e) Can be diagnosed by the presence of a goiter f) often occurs weeks after exposure to ionizing radiation

B, C, D

A nurse is admitting a patient with hypothyroidism. Which of the following signs and symptoms will the nurse expect? (Select all that apply) A) Increased appetite B) Cold Intolerance C) Constipation D) Hypotension E) Bulging eyeballs F) Slow heart rate G) Weight loss H) Fever I) Rapid Respiratory Rate

B, C, D, F

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) a) goiter b) nonpitting edema of hands and feet c) warm, moist skin d) decreased deep tendon reflexes e) agitation and inability to sleep f) pulse rate below 60 beats/min

B, D, F

Which assessment findings in a client with hyperthyroidism indicate to the nurse that the client is in danger of thyroid storm? SATA: a) increased salivation b) client report of increased palmar sweating c) decreased pulse pressure from 40mmhg to 36mmhg d) diminished bowel sounds in all 4 abdominal quadrants e) an increase in temperature from 99.5 to 101.3 f) Serum Na level increase from 136 to 139 g) increase in premature ventricular heart contractions from 4 per minute to 28 per minute

B, E, G

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). Which of the following education should the nurse provide to patient? A) not to wash away the external markings. B) that symptoms of hyperthyroidism should be relieved in about a week. C) that symptoms of hypothyroidism may occur as the RAI therapy takes effect. D) to discontinue the antithyroid medications taken before the radioactive therapy.

C

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first? a. Administer the ordered muscle relaxant. b. Give the ordered oral calcium supplement. c. Have the patient rebreathe from a paper bag. d. Start the PRN oxygen at 2 L/min per cannula.

C

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? A) Observe the dressing for bleeding. B) Check the blood pressure and pulse. C) Assess the patient's respiratory effort. D) Support the patient's head with pillows.

C

An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering: a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).

C

The nurse reviewing the lab values of a client with hypoparathyroidism finds a serum calcium level of 7.9. Which parameter is most important for the nurse to assess to prevent harm? a) temperature b) heart rate and rhythm c) deep tendon reflexes d) LOC

C

Which assessment finding for a 33-year-old female patient admitted with Graves disease requires the most rapid intervention by the nurse? a. Bilateral exophthalmos b. Heart rate 136 beats/minute c. Temperature 103.8 F (40.4 C) d. Blood pressure 166/100 mm Hg

C

Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed? a) hypoactive bowel sounds b) apical pulse of 92 beats/min c) bilateral leg muscle twitching d) dry mouth

C

Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.

C

Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)? a) "Increase the amount of fiber in your diet to prevent the side effect of constipation." b) "Stop this drug immediately if you discover you are pregnant." c) "Avoid over-the-counter medications unless prescribed by your primary health care provider." d) "If you miss a dose, double your next day's dose."

C

Which statement made by a client who is undergoing therapy with radioactive iodine (RAI) for Graves disease indicates a lack of understanding about the disorder and its treatment? a) "Luckily, I have my own bathroom, so I won't be exposing the rest of my family to radiation." b) "If this treatment works, maybe I will stop sweating all the time." c) "It will be great to lose my "bug-eyed" appearance." d) "I hope I don't gain too much weight when my thyroid function is normal."

C

Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism? a) Antipyretics b) opioid analgesics c) furosemide diuretic d) calcium supplements

C

An assistive personnel reports that a nursing home client who has hypothyroidism has a pulse of 48 beats/min this morning. Which assessments have the highest priority for the nurse to perform immediately? SATA: a) checking body temperature b) testing deep tendon reflex responses c) measuring oxygen saturation by pulse oximetry d) checking BP, HR and rhythm e) determining LOC and consciousness f) identifying presence or absence of the swallowing reflex g) examining feet/ankles for indications of peripheral edema

C, D

Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) a) hypertonic saline b) furosemide c) calcium gluconate d) oxygen e) suction f) emergency tracheostomy kit

C, D, E, F

A patient with Grave's Disease is day-1 post-op from abdominal surgery. The patient states that she thinks she may have a fever, which the nurse confirms with an oral temperature of 101.2 degrees F. What is the next action the nurse should take? A) Call rapid response B) Check the patient's incision site. C) Palpate the thyroid gland. D) Obtain a set of vital signs.

D

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops: a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing. d. laryngospasms and tingling in the hands and feet.

D

For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider? a) calf muscle cramping b) runny nose c) anorexia d) hand tremors

D

The nurse reviews the vital signs of a client diagnosed with Graves disease and notes that the client's temperature is 99.6° F (37.6° C). After notifying the primary health care provider, what is the nurse's best next action? a) Administer acetaminophen b) Observe for the presence of chills c) Initiate the Rapid Response Team d) Assess cardiac status

D

What is the nurse's best response when family members of a client with hyperthyroidism express concern about the client's frequent mood swings? a) "Do the client's mood swings make you feel angry?" b) "The medications will make the mood swings disappear completely." c) "Your family member is sick. You must be patient." d) "Mood swings are common should diminish with treatment."

D

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) Administer morphine for pain b) Assess the wound dressing for bleeding c) Hyperextending the neck d) Monitor oxygen saturation

D

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? a) Increasing the IV infusion rate b) Initiating the Rapid Response Team c) Assessing temperature d) Applying oxygen by mask

D

Which changing trends in a client's serum laboratory values indicate to the nurse that thyroid hormone replacement therapy for hypothyroidism is effective? a) Declining thyroglobulin (Tg) levels; rising thyrotropin receptor antibody (TRAb) levels b) Declining thyroid hormone (TH) levels; rising thyroid-stimulating hormone (TSH) levels c) Rising thyroglobulin (Tg) levels; declining thyrotropin receptor antibody (TRAb) levels d) Rising thyroid hormone (TH) levels; declining thyroid-stimulating hormone (TSH) levels

D