Hyperthyroidism

Exophthalmos (protruding eyeballs) may occur in children with? A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyrodisim

Exophthalmos is a clinical manifestation of hyperthyrodisim.

Which nursing assessment of a 70 year old patient is MOST important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? A. Apical pulse rate B. Fluid balance C. Orientation & alertness D. Nutritional intake

A. In older patients, initiation of levothyroxine can increase myocardial oxygen demand & cause angina or dysrhythmias. The medication also is expected to improve mental status, fluid balance, & increase metabolic rate & nutritional needs but these changes will not result in potentially life threatening complications.

The nurse is caring for a school age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all) A. Hyperthermia B. Constipation C. Hypotension D. Tachycardia E. Vomiting

A child with thyroid storm will have severe irritability & restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, & prostration. Answers: A, D, E

Post op, after a thyroidectomy, what should the nurse have at the patient's bedside? (Select all) A. Oxygen B. NG tube C. Suction D. Trach tray E. IV calcium

A, C, D, E

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm? a. Propranolol (Inderal) b. Propylthiouracil (PTU) c. Methimazole (Tapazole) d. Iodine (Lugol's solution)

A. B-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other meds take days to weeks.

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis & a goiter will require the MOST immediate action? A. New onset changes in the patient's voice B. Elevation in the patient's T3 & T4 levels C. Resting apical pulse rate 112 beats/min D. Bruit audible bilaterally over the thyroid gland

A. Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve & may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis & do not require immediate action.

A RN is caring for a patient with a goiter & possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching? A. The RN palpates the neck to assess thyroid size B. The RN check the blood pressure in both arms C. The RN order saline eye drops to lubricate the patient's bulging eyes D. The RN lowers the thermostat to decrease the temperature in the room

A. Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid & should be avoided. The other actions are appropriated when caring for a patient with an enlarged thyroid.

Which diagnostic tests would relieve hyperthyroidism? (Select all) A. Increased TSH levels B. Decreased TSH levels C. Increased T4 levels D. Decreased T4 levels

B, C

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? A. Iodine B. Propranolol (Inderal) C. Methimazole D. Propylthiouracil

B. B-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.

The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching? A. "I would expect my child to gain weight while taking this medication" B. "If my child develops a sore throat & fever, I should contact the physician immediately" C. "I would expect my child to experience episodes of ear pain while taking this medication" D. "If my child develops the stomach flu, my child will need to be hospitalized"

B. Children being treated with propylthiouracil must be carefully monitored for the side effect of the drug. Parents must be alerted that sore throat & fever accompany the grave complications of leukopenia. These symptoms should be immediately reported.

Which statement by a 50 year old female patient indicates to the nurse that further assessment of thyroid function may be necessary? A. "I get up several times at night to urinate" B. "I feel a lump in my throat when I swallow" C. "I notice my breasts are tender lately" D. "I am so thirsty that I drink all day long"

B. Difficulty in swallowing can occur with a goiter.

What is the priority nursing goal for a 14 year old with Graves' disease? A. Allowing the adolescent to make decisions about whether or not to take medication B. Verbalizing the importance of adherence to the medication regime C. Relieving constipation D. Developing alternative educational goals

B. In order to adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves' disease is not likely to be constipated. Adherence to the medication schedule is important to ensure optimal health & wellness.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? a. "How much milk do you drink?" b. "What medications are you taking?" c. "Are your immunizations up to date?" d. "Have you had any recent neck injuries?"

B. Medications that contain thyroid inhibiting substances can cause goiter. Milk intake, neck injury, & immunization history are not risk factors for goiter.

A 40 year old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is MOST important to communicate to the surgeon? A. Difficult to awaken B. Increasing neck swelling C. Reports 7/10 incisional pain D. Cardiac rate 112 beats/min

B. The neck swelling my lead to respiratory difficulty & rapid intervention is needed to prevent airway obstruction. Incisional pain should be treated but is not unusual after surgery. Heart rate of 112 not unusual in a patient who has hyperthyroid. Sleepiness in the immediate postoperative period is expected.

During the nurse's physical examination of a young adult, the patient's thyroid gland cannot be felt. The most appropriate action by the nurse is to a. palpate the patient's neck more deeply. b. document that the thyroid was nonpalpable. c. notify the health care provider immediately. d. teach the patient about thyroid hormone testing.

B. The thyroid is frequently nonpalpable. The nurse would simply document the finding.

After receiving change-of-shift report on the following four patients, which patient should the nurse see first? A. 31 yr old female patient w/Cushing syndrome & a blood glucose level of 244 mg/dL B. 53 yr old male patient who has Addison's disease & is due for a prescribed dose of hydrocortisone (Solu-Cortef) C. 70 yr old female taking levothyroxine (Synthroid) who has an irregular pulse of 134 D. 22 yr old male patient admitted with SIADH who has serum sodium level of 130 mEq/L

C. Initiation of thyroid replacement in older adults may cause angina & cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for & intervene with any cardiac problems.

A patient develops carpopedal spasms & tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms? A. Administer the prescribed muscle relaxant B. Start PRN O2, at 2 L/min per cannula C. Have the patient rebrethe from a paper bag D. Stretch the muscles with passive range of motion

C. The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 & create a more acidic pH.

Which question from a nurse during a patient interview will provide focused information about a possible thyroid disorder? A. "What methods do you use to help cope with stress" B. "Have you experienced any blurring or double vision" C. "Have you had a recent unplanned weight gain or loss" D. "Do you have to get up at night to empty your bladder"

C. Thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland.

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. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway.

What are the clinical manifestations of hyperthyroidism? (Select all) A. Weight loss B. Weight gain C. Heat intolerance D. Increase HR E. Diarrhea F. Constipation

Clinical manifestations of hyperthyroidism include: weight loss (active GI), heat intolerance, increased HR & BP, & diarrhea. Answers: A, C, D, E

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 Addison's disease who takes hydrocortisone twice daily B. Patient with Hashimoto's thyroiditis & a heart rate of 102 C. Patient with Cushing syndrome & a blood glucose of 140 mg/dL D. Patient with tetany who has a new order for IV calcium chloride

D. Emergency treatment of tetany requires IV administration of calcium, electrocardiographic monitoring will be required because cardiac arrest may occur if high calcium levels result form too rapid administration.

Which information will the nurse teach a 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. Surgery will eventually be required to remove the thyroid gland D. Antithyroid medications may take several months for full effect

D. Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged. Radioactive iodine is the most common treatment for Graves' disease although surgery may be used.

Which clinical manifestation my occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves' disease)? A. Seizures B. Pancreatitis or cholecystitis C. Enlargement of all lymph glands D. Lethargy & somnolence

D. Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy & somnolence.

Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos? A. Place cold packs on the eyes to relieve pain & swelling B. Apply alternating eye patches to protect the corneas from irritation C. Teach the patient to blink every few seconds to lubricate the corneas D. Elevate the head of the patient's bed to reduce periorbital fluid

D. The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes rather than eye patches will protect eyes. Cold packs will not help the swelling.

Which assessment findings for a 35 yr old female patient admitted with Graves' disease requires the MOST rapid intervention by th nurse? A. Severe bilateral exophthalmos B. Heart rate 136 beats/min C. Blood pressure 166/100 mm Hg D. Temperature 103. 8 F

D. The patient's temperature indicates that the patient may have thyrotoxic crisis & that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life threatening complications.

A 62 year old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient? A. To discontinue the antithyroid medications taken before the radioactive therapy B. About radioactive precautions to take with all body secretions C. Symptoms of hyperthyroidism should be relieved in a about a week D. Symptoms of hypothyroidism may occur as the RAI therapy takes effect

D. There is high incidence of post radiation hypothyroidism after RAI & the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response w/maximum effect not seen for 2 to 3 months & the patient will continue to take antithyroid medications.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor & a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate NEXT? A. Plan for emergency tracheostomy B. Suction the patient's airway C. Prepare for endotracheal intubation D. Administer IV calcium gluconate

D. The patient's clinical manifestations of stridor & cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Suctioning will not correct stridor. If calcium does not resolve stridor, endotracheal intubation or tracheostomy may be needed.