N300 Exam 2: Thyroid Disorders
The nurse is giving an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the United States get goiters as often?" Which state- ment by the nurse is the best response? 1. "It is because of the screening techniques used in the United States." 2. "It is a genetic predisposition that is rare in North Americans." 3. "The medications available in the United States decrease goiters." 4. "Iodized salt helps prevent the development of goiters in the United States."
1. There is no screening for thyroid disorders, just serum thyroid levels. 2. This is not a true statement. 3. Medications do not decrease the development of goiters. 4. Almost all of the iodine that enters the body is retained in the thyroid gland. A deficiency in iodine will cause the thyroid gland to work hard and enlarge, which is called a goiter. Goiters are commonly seen in geographical regions that have an iodine deficiency. Most table salt in the United States has iodine added. TEST-TAKING HINT: The nurse must know about disease processes. There is no test- taking hint that will help determine the answer to the question.
The client is diagnosed with hypothyroidism. Which signs/symptoms would the nurse expect the client to exhibit? 1. Complaints of extreme fatigue and hair loss. 2. Exophthalmos and complaints of nervousness. 3. Complaints of profuse sweating and flushed skin. 4. Tetany and complaints of stiffness of the hands.
**1. A decrease in the thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss. 2. These are signs of hyperthyroidism. 3. These are signs of hyperthyroidism. 4. These are signs of parathyroidism. TEST-TAKING HINT: Often if the test taker does not know the specific signs/symptoms of the disease but knows the function of the system that is affected by the disease, some possible answers can be ruled out. Tetany and stiffness of the hands are related to calcium, the level of which is influenced by the parathyroid gland, not the thyroid gland; therefore, option "4" can be ruled out. All of the other three options relate to metabolism, which is regulated by the thyroid gland. The test taker must decide which option lists symptoms of decreased thyroid function
The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client? 1. Explain that it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach that the iodine therapy will have to be tapered slowly over one (1) week. 3. Discuss that the client will have to be hospitalized during the radioactive therapy. 4. Inform the client that 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 therapy is administered; the dosage is based on the client's weight. 3. The colorless, tasteless radioiodine is administered by the radiologist, and the client may have to stay up to two (2) hours after the treatment in the office. 4. If too much of the thyroid gland is destroyed by the radioactive iodine therapy, the client may develop hypothyroidism and have to take thyroid hormone the rest of his or her life. TEST-TAKING HINT: Some questions require the test taker to be knowledgeable of the information, especially medical treatments, and there are no specific hints to help the test taker answer the question.
The nurse is teaching the client diagnosed with hyperthyroidism. Which information should be taught to the client? Select all that apply. 1. Notify the HCP if a three (3)-pound weight loss occurs in two (2) days. 2. Discuss ways to cope with the emotional lability. 3. Notify the HCP if taking over-the-counter medication. 4. Carry a medical identification card or bracelet. 5. Teach how to take antithyroid medications correctly.
**1. Weight loss indicates the medication may not be effective and will probably need to be increased. **2. The client needs to know that emotional highs and lows are secondary to hyperthyroidism. With treatment this emotional liability will subside. **3. Any over-the-counter medications (for example, alcohol-based medications) may negatively affect the client's hyperthyroidism or medications being used for treatment. **4. This will help any HCP immediately know of the client's condition, especially if the client is unable to tell the HCP. **5. The client may be receiving antithyroid medications and should know how to take them properly. TEST-TAKING HINT: This alternate-type question instructs the test taker to select all the interventions that apply. The test taker should not try to outguess the test writer; in some instances all the options are correct.
Which signs/symptoms would make the nurse suspect that the client is experiencing a thyroid storm? 1. Obstipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.
1. These are signs of myxedema (hypothy- roidism) coma. Obstipation is extreme consti- pation. **2. Hyperpyrexia (high fever) and heart rate above 130 beats/minute are signs of thyroid storm, a severely exaggerated hyperthyroidism. 3. Decreased blood pressure and slow heart rate are signs of myxedema coma. 4. These are signs/symptoms of myxedema coma. TEST-TAKING HINT: If the test taker does not have the knowledge to answer the question, then the test taker should look at the options closely. Options "1," "3," and "4" all have signs/symptoms of "decrease"—hypoactive, hypotension, and hypoxia. The test taker should select the option that does not match.
Which medication order would the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.
1. Thyroid hormones are the treatment of choice for the client diagnosed with hypothyroidism; therefore, the nurse would not question this medication. 2. In untreated hypothyroidism, the medical management is aimed at supporting vital functions, so administering oxygen would be an appropriate medication. **3. Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse would question this medication. 4. Clients with hypothyroidism become consti- pated as a result of decreased metabolism, so laxatives would not be questioned by the nurse. TEST-TAKING HINT: When a question asks which order the nurse would question, three of the options would be orders that the nurse would expect to administer to the client. Sometimes saying, "The nurse would administer this medication," may help the test taker select the correct answer.
Which statement made by the client would make the nurse suspect that the client is experiencing hyperthyroidism? 1. "I just don't seem to have any appetite anymore." 2. "I have a bowel movement about every 3 to 4 days." 3. "My skin is really becoming dry and coarse." 4. "I have noticed that all my collars are getting tighter."
1. Decreased appetite is a symptom of hypothy- roidism, not hyperthyroidism. 2. Constipation is a symptom of hypothyroidism. 3. Dry, coarse skin is a sign of hypothyroidism. **4. The thyroid gland (in the neck) enlarges as a result of the increased need for thyroid hormone production; an enlarged gland is called a goiter. TEST-TAKING HINT: If the test taker does not know the answer, sometimes thinking about the location of the gland or organ that is causing the problem may help the test taker select or rule out specific options.
The nurse identifies the client problem "risk for imbalanced body temperature" for the client diagnosed with hypothyroidism. Which intervention would be included in the client problem? 1. Encourage the use of an electric blanket. 2. Protect from exposure to cold and drafts. 3. Keep the room temperature cool. 4. Space activities to promote rest.
1. External heat sources (heating pads, electric or warming blankets) should be discouraged because they increase the risk of peripheral vasodilatation and vascular collapse. **2. Decreased metabolism causes the client to be cold frequently; therefore, protecting the client from exposure to cold will help increase comfort and decrease further heat loss. 3. The room temperature should be kept warm because the client will have complaints of being cold. 4. The client is fatigued and this is an appropriate intervention, but it would not be applicable to the client problem of "risk for imbalanced body temperature." TEST-TAKING HINT: The test taker must always know exactly what the question is asking. Option "4" can be ruled out because it does not address body temperature. If the test taker knows the normal function of the thyroid gland, this may help identify the answer; decreased metabolism will cause the client to be cold.
Which nursing intervention should be included in the plan of care for the client diag- nosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1000 mL day. 4. Provide six (6) small, well-balanced meals a day.
1. Fiber should be increased in the client diag- nosed with hypothyroidism because the client experiences constipation secondary to de- creased metabolism. 2. The client with hyperthyroidism should have a high-calorie, high-protein diet. 3. The client's fluid intake should be increased to replace fluids that are lost through diarrhea and excessive sweating. **4. The client with hyperthyroidism has an increased appetite; therefore, well-balanced meals served several times throughout the day will help with the client's constant hunger. TEST-TAKING HINT: If the test taker knows that with hyperthyroidism the metabolism is increased, then increasing the food intake would be the most appropriate choice.
The client with hypothyroidism is admitted to the intensive care department diag- nosed with myxedema coma. Which assessment data would warrant immediate inter- vention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.
1. Hypoglycemia is expected in a client with myxedema; therefore a 74 blood glucose level would be expected. **2. A pulse oximeter reading of less than 93% is significant. A 90% pulse oximeter read- ing indicates a PaO2 of approximately 60 on an arterial blood gas; this is severe hypox- emia and requires immediate intervention. 3. The client with myxedema coma is in an exag- gerated hypothyroid state; a low pulse is expected in a client with hypothyroidism. 4. Lethargy is an expected symptom in a client diagnosed with myxedema; therefore this would not warrant immediate intervention. TEST-TAKING HINT: The words "warrants immediate intervention" mean the test taker should select an option that is abnormal for the disease process or a symptom that is life threatening or life altering.
The client diagnosed with hypothyroidism is prescribed the thyroid hormone levothy- roxine (Synthroid). Which assessment data indicate the medication has been effective? 1. The client has a three (3)-pound weight gain. 2. The client has a decreased pulse rate. 3. The client's temperature is WNL. 4. The client denies any diaphoresis.
1. The medication will help increase the client's metabolism rate. A weight gain would indicate that not enough medication is being taken to put the client in a euthyroid (normal thyroid) state. 2. A decreased pulse rate indicates that there is not enough thyroid hormone level; therefore the medication is not effective. **3. The client with hypothyroidism frequently has a subnormal temperature, so a temper- ature WNL indicates the medication is effective. 4. Diaphoresis (sweating) occurs with hyperthy- roidism, not hypothyroidism. TEST-TAKING HINT: One way of determining the effectiveness of medication is to determine if the signs/symptoms of the disease are no longer noticeable.
The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. The thyroid hormone to the client that does not have a T3, T4 level. 2. The regular insulin to the client with a blood glucose level of 210 mg/dL. 3. The loop diuretic to the client with a potassium level of 3.3 mEq/L. 4. The cardiac glycoside to the client who has a digoxin level of 1.4 mg/dL.
1. The thyroid hormone must be given daily, and thyroid levels are drawn every six (6) months or so. 2. A blood glucose level of 210 mg/dL requires insulin administration; therefore the nurse would not question giving this medication **3. This potassium level is below normal, which is 3.5-5.5 mEq/L. Therefore, the nurse would question administering this medication because loop diuretics cause potassium loss in the urine. 4. This digoxin level is within therapeutic range—0.8-2.0 mg/dL; therefore the nurse would administer this medication. TEST-TAKING HINT: When administering medication the nurse must know when to question the medication, how to know it is effective, and what must be taught to keep the client safe while taking the medication. The test taker may want to turn the question around and say, "I would give this medication."