EAQ CH. 63
Which assessment finding does the nurse associate with Graves' disease?
Abnormal protrusion of the eyes Exophthalmos, or abnormal protrusion of the eyes, is specific to Graves' disease. Manifestations of hyperthyroidism include increased sweating or diaphoresis because of heat intolerance. Dyspnea with or without exertion is also common in patients with hyperthyroidism]
Which causes of hypothyroidism result from a decrease in thyroid tissue? Select all that apply.
Cancer (thyroidal or metastatic), Autoimmune thyroid destruction, Congenital poor thyroid development Hypothyroidism related to a decrease in thyroid tissue may result from cancer (thyroidal or metastatic), autoimmune thyroid destruction, or congenital poor thyroid development. Endemic iodine deficiency results in decreased synthesis of thyroid hormone. Congenital pituitary defects and pituitary tumors, trauma, infections, or infarcts result in inadequate production of thyroid-stimulating hormone.]
Which problems commonly occur with myxedema? Select all that apply.
Coma, hypothermia, hypoglycemia, respiratory failure [Common problems that occur with myxedema include coma, hypothermia, hypoglycemia, and respiratory failure. Hypotension, not hypertension, is a problem with myxedema. Hyponatremia, not hypernatremia, is a concern with myxedema.]
While assessing a patient with an endocrine disorder, the nurse hears an audible bruit over the thyroid gland. The presence of a mass or cyst is noted on the patient's ultrasound report. The primary health care provider prescribes radioactive iodine. What condition might the patient be experiencing?
Hyperthyroidism An audible bruit heard over the thyroid gland because of increased blood flow is an indication of hyperthyroidism. A mass or cyst indicates an enlarged thyroid gland, which may be a goiter. The primary health care provider prescribes radioactive iodine therapy to ablate the enlarged thyroid gland. Hypothyroidism is characterized by weight gain and impaired cardiac and respiratory functions and is treated with levothyroxine, which is a thyroid hormone supplement. Hypoparathyroidism is characterized by excessive or inappropriate muscle contractions and is treated with parathormone. Hyperparathyroidism is characterized by weight loss, an increased risk of fracture, and renal calculi. It is treated with calcitonin.]
A patient with hypothyroidism is being discharged. Which environmental change may need to be made in the patient's home.
Increased thermostat setting [Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary. A patient 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 patient with hypothyroidism is not immune-compromised or contagious, so no environmental changes need to be made to the home.]
A patient has been diagnosed with hypothyroidism. What medication is routinely prescribed to treat this disorder?
Levothyroxine sodium [Levothyroxine is a synthetic form of T 4 that is used to treat hypothyroidism. Atenolol is a beta blocker that is used to treat cardiovascular disease. Methimazole and propylthiouracil are used to treat hyperthyroidism.]
Which manifestation is a hallmark sign of hyperthyroidism?
Poor thermoregulation [A hallmark sign of hyperthyroidism is poor thermoregulation with heat intolerance. The patient may have increased sweating even when the temperature of the environment is comfortable for others. Eye fatigue, weight loss, and increased libido are also features of hyperthyroidism but are not hallmark signs.]
A patient with Graves' disease can potentially develop thyroid storm. What factor can trigger thyroid storm in the patient?
Vigorous palpation of the goiter [Vigorous palpation of the goiter can trigger a thyroid storm or thyroid crisis in a patient with Graves' disease. The manifestations of thyroid storm are caused by release of thyroid hormone in large amounts, increasing the metabolic rate. Exposure to iodine or radioactive iodine therapy can trigger thyroid storm in the patient. Artificial tears are used to prevent dryness of the eyes in patients with exophthalmos; it does not cause thyroid storm. The patient with hyperthyroidism is intolerant to heat. Reduced room temperature provides comfort and would not cause thyroid storm.]
What assessment finding indicates a possibility of hyperthyroidism in a patient?
Considerable loss of weight without dieting [A patient who is not on a diet but has lost considerable weight is a likely candidate for hyperthyroidism. Although hyperthyroidism can cause increased appetite, there is considerable weight loss and an increase in the number of bowel movements per day. The patient with hyperthyroidism is intolerant to heat, not cold, and has diaphoresis. Bradycardia is indicative of hypothyroidism; an elevated heart rate is a sign of hyperthyroidism.]
Which are common symptoms of hypothyroidism? Select all that apply.
Anorexia, Impaired Memory, Poor wound Healing [Common symptoms of hypothyroidism include anorexia, impaired memory, and poor wound healing. Individuals with hypothyroidism often experience a decreased body temperature and cold intolerance, not hot flashes. Individuals with hypothyroidism generally present with hypotension and hypoventilation, not hypertension or hyperventilation. ]
Which autoimmune disorder may be triggered by a bacterial or viral infection?
Hashimoto's disease [Chronic thyroiditis, also known as Hashimoto's disease, is an autoimmune disorder that may be triggered by a bacterial or viral infection. Graves' disease is also an autoimmune disorder that results in hyperthyroidism. Thyroid cancer may be congenital or may be caused by various factors such as infections or surgical injury. Myxedema coma is a complication of untreated hypothyroidism; it is not an autoimmune disorder.]
Which are symptoms of hyperthyroidism? Select all that apply.
Insomia, Palpitations, Low Grade Fever, Restlessness and Irritability [Symptoms of hyperthyroidism include insomnia, palpitations, low-grade fever, and restlessness or irritability. Hyperthyroidism results in rapid, shallow respirations. Appetite is increased in people with untreated hyperthyroidism.]
Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II?
Medullary [Medullary carcinoma commonly occurs as part of MEN type II, which is a familial endocrine disorder. Anaplastic carcinoma is an aggressive tumor that invades surrounding tissue. Follicular carcinoma occurs more frequently in older patients and may metastasize to bone and lung. Papillary carcinoma is the most common type of thyroid cancer. It is slow-growing and if the tumor is confined to the thyroid gland, the outlook for a cure is good with surgical management.]
Which nursing intervention is beneficial for a patient with hyperthyroidism?
Monitoring the patient's body temperature every 4 hours An increase in body temperature indicates a rapid worsening of the patient's condition and the onset of a thyroid storm, which is a life-threatening condition. As a result, the nurse should monitor the patient's body temperature every 4 hours. Checking body weight daily is beneficial for patients with hypothyroidism because they have rapid weight gain. The nurse asks about tingling around the mouth or in the toes and fingers for patients who have had their parathyroid gland removed because they may experience hypocalcemia and tetany. Using artificial tears is encouraged for the patient with exophthalmos.]
Which type of thyroid cancer is most common?
Papillary Papillary carcinoma is the most common type of thyroid cancer, and it occurs most often in young women. Follicular, medullary, and anaplastic carcinomas occur less frequently.]
What is the most common cause of hypothyroidism in the United States?
Radioactive iodine treatment [The most common cause of hypothyroidism in the United States is radioactive iodine (RAI) treatment and thyroid surgery for hyperthyroidism. Hypothyroidism was common in the Midwest region of the U.S. before iodide was added to table salt and saltwater fish was widely available. Tyrosine and iodide are compounds essential to produce thyroid hormones. Saltwater fish is a good source of iodide and prevents hypothyroidism. Endemic goiter due to hypothyroidism is found in areas where soil and water have little natural iodide.]
What is follicular carcinoma of the thyroid?
The cancer invades blood vessels. [In follicular carcinoma of the thyroid, the cancer invades blood vessels and spreads to the bone and lung tissue. Papillary carcinoma is a slow-growing tumor confined to the thyroid gland. In medullary carcinoma, the tumor secretes calcitonin.]
Which eye assessment finding is known as a "globe lag?"
The upper eyelid pulls back faster than the eyeball when the patient gazes up [Globe or eyeball lag is a problem found in patients with hyperthyroidism and occurs when the upper eyelid pulls back faster than the eyeball when the patient gazes up. Eyelid retraction, or eyelid lag, is a condition in which the upper eyelid fails to descend when the patient gazes down. Patients with photophobia have excessive tearing and eyes that appear bloodshot. Exophthalmos is common in patients with Graves' disease in which the patient has a wide-eyed, startled look at all times.]
