NUR113 - Thyroid
The nurse reviews the vital signs of a patient diagnosed with Graves' disease. The patient's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next?
Correct4 Assesses the patient's cardiac status completely. If the patient's temperature has increased by even one degree, the nurse's first action is to notify the provider. Continuous cardiac monitoring should be the next step
The nurse is caring for a patient diagnosed with Graves' disease. Which other term is used to define the patient's condition?
toxic diffuse goiter Graves' disease, also known as toxic diffuse goiter, is an autoimmune disorder in which the thyroid gland enlarges to form a goiter and overproduces thyroid hormones. The disease is caused by hyperthyroidism. Hypothyroidism is a disorder caused by low levels of thyroid hormones. Toxic multinodular goiter is hyperthyroidism caused by multiple thyroid nodules. Exogenous hyperthyroidism is a condition caused by the excessive use of thyroid replacement hormones. p 1265
A patient is being discharged with propylthiouracil (PTU). Which statement by the patient indicates a need for further teaching by the nurse?
"I can return to my job at the nursing home." The patient should avoid large crowds and people who are ill because propylthiouracil reduces blood cell counts and the immune response, which increases the risk for infection. The patient does not need to remain completely at home. Dark urine may indicate liver toxicity or failure and the patient must notify the provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures better drug action. The patient must notify the provider of weight gain because this may indicate hypothyroidism; a lower drug dose may be required. p 1268
The nurse is evaluating how well a patient understands the hormonal replacement therapy that has been prescribed for the management of hypothyroidism. Which patient statement indicates a need for further teaching?
"I can stop taking my medications when I feel better." A patient with hypothyroidism will need to take hormonal therapy for the rest of his or her life, not just until he or she feels better. p 1273
The nurse is teaching a patient about thyroid replacement therapy. Which statement by the patient indicates a need for further teaching?
"If I continue to lose weight, I may need an increased dose." 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 patient have more energy. The correct time to take thyroid replacement therapy is in the morning. If the patient is gaining weight and continues to feel tired, that is an indication that the dose may need to be increased.
A patient is taking methimazole for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response?
"You should see some effects of this medication within 2 weeks."
A patient has been prescribed radioactive iodine (RAI) therapy for hyperthyroidism. What does the nurse teach the patient about this therapy?
"You will receive RAI in the form of oral 131I. RAI is provided in the form of oral 131I. The dosage depends on the size of the thyroid gland and its sensitivity to radiation. Some of the cells that produce thyroid hormone are destroyed. However, the thyroid gland also stores thyroid hormones to an extent. Therefore, the patient may not have complete relief of symptoms until 6 to 8 weeks after RAI therapy. Radioactivity is present in the patient's body fluids and stool for a few weeks even after the therapy is complete. The patient must take radiation precautions to prevent exposure to family members and other people. RAI treatment is done on an outpatient basis; most patients require only one sitting, whereas some may require two or three sittings
Which physiological effect does the nurse expect to find in a patient with thyroiditis?
Dysphagia Thyroiditis is inflammation of the thyroid gland caused by a bacterial or viral infection. Its physiological effects include dysphagia, pain, neck tenderness, and fever. Weight gain is seen in patients with hypothyroidism as a result of decreased metabolism. Heat intolerance is characteristic of hyperthyroidism. Cold intolerance is a manifestation of hypothyroidism. p 1275
A patient admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. Based on the patient's symptoms, what should the nurse do?
Encourage the patient to rest The patient with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse should accept the patient's behavior and provide a calm, quiet, and comfortable environment. Because the patient's behavior is expected, there is no need to call the provider.
The nurse is examining the eyes of a patient and notes that the upper eyelid fails to descend when the patient slowly gazes downward. What term does the nurse use to document this finding?
Eyelid lag
A nurse is assessing a patient with a goiter due to hypothyroidism. What factor causes a goiter in this patient?
Increase in the production of thyroid-stimulating hormones (TSH) The patient with hypothyroidism has low levels of thyroid hormone and a decreased metabolic rate. This causes the hypothalamus and anterior pituitary gland to increase production of TSH. TSH binds to the thyroid cells and forms a goiter. p 1271
The nurse is monitoring a patient who had a thyroidectomy. What manifestation indicates injury to the parathyroid gland?
Muscle twitching Muscle twitching is a sign of calcium deficiency. Injury to the parathyroid gland results in hypocalcemia or low serum calcium levels. Hemorrhage is most likely to occur in the first 24 hours after surgery but is not related to damage to the parathyroids. Hoarseness and weak voice may occur as a result of laryngeal nerve damage during the surgery. p 1270
The condition of a pregnant patient with hyperthyroidism rapidly worsens and leads to thyroid storm. What are the appropriate drugs and their sequence of administration?
Oral administration of Lugol's solution 1 hour after propylthiouracil In a thyroid storm, iodine-containing drugs (Lugol's solution) are administered 1 hour after the thionamides (methimazole and propylthiouracil). Initially, the iodine agents can cause an increase in the production of thyroid hormones. Therefore, administering a thionamide first prevents this initial increase in thyroid hormone production. Methimazole can cause birth defects and should not be used during pregnancy, especially during the first trimester. Simultaneous administration of Lugol's solution and propylthiouracil is not effective in preventing the initial increase in thyroid hormone production from the iodine agent. p 1268
Which type of thyroiditis does the nurse suspect in a patient who complains of cold, fever, chills, dysphagia, and muscle and joint pains?
Subacute thyroiditis Subacute or granulomatous thyroiditis results from a viral infection of the thyroid gland after a cold or other upper respiratory infection. Manifestations include fever, chills, dysphagia, and muscle and joint pain. p 1275
The nurse is reviewing the laboratory reports of four patients. Grave's disease should be expected in which patient?
T3 88. T4 14. TSH 0.1 The normal range of T 3is 80-180 ng/dl, T 4is 4.6-12 ug/dL, and TSH is 0.3 to 5.0μU/mL. In Patient 3, T 3and T 4are elevated, and TSH is decreased. Elevated T 3and T 4with reduced TSH indicate Grave's disease. p 1267
Family members of a patient diagnosed with hyperthyroidism voice concern regarding the patient's frequent mood swings. How should the nurse respond to the family members?
Telling the family that the patient's mood swings should diminish over time with treatment will provide information to the family, as well as reassurance. p 1270
What should the nurse be aware of when caring for a patient with acute thyroiditis?
The condition is usually resolved with antibiotic therapy. Acute thyroiditis is caused by bacterial invasion of the thyroid gland. It is usually resolved with antibiotic therapy. Subacute or granulomatous thyroiditis results from a viral infection of the thyroid gland. It usually occurs after a cold or other respiratory infection. Chronic thyroiditis or Hashimoto's disease is an autoimmune disorder. It is usually triggered by a bacterial or viral infection. In subacute thyroiditis, the thyroid gland feels hard and enlarged on palpation. p 1275
What should be suspected in a 60-year-old female patient diagnosed with a goiter who does not display signs of exophthalmos and pretibial myxedema?
Toxic multinodular goiter
A patient who underwent a thyroid scan tested positive for multiple thyroid nodules. What percentage (%) of radioactive iodine uptake (RAIU) by the thyroid gland does the nurse anticipate?
50% The normal thyroid gland has an uptake of 5% to 35% of the given dose at 24 hours. RAIU is increased in hyperthyroidism and can be used to identify active thyroid nodules. An uptake of 50% clearly suggests the presence of multiple thyroid nodules. An uptake of 5%, 15%, or 30% is considered normal. p 1267
A patient 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?
Ask whether the patient has increased cold sensitivity or weight gain Increased sensitivity to cold and weight gain are symptoms of hypothyroidism, indicating an overcorrection of the medication. The patient must be assessed further because he may require a lower dose of medication. p 1268
What does the nurse expect to find when assessing a patient with hyperthyroidism?
Increased appetite The patient with hyperthyroidism reports an increase in appetite. Hyperthyroidism causes increased metabolism; as a result, fat metabolism is increased. This leads to weight loss and a reduction in body fat. The patient with hyperthyroidism has decreased glucose tolerance, leading to hyperglycemia or increased blood glucose.
A patient who is receiving thyroid replacement therapy for hypothyroidism reports constipation and insomnia. What should be included in this patient's plan of care?
Increasing the medication dose A patient with thyroid replacement therapy is required to have a dose adjustment depending on clinical parameters and signs and symptoms. The medication dose should be increased when the patient experiences insomnia and is constipated. p 1274
Which assessment finding is considered a grade 1 goiter?
No visible thyroid enlargement when the neck is in a normal position The patient with a grade 1 goiter does not have thyroid enlargement, which normally is visible when the neck is in normal position. However, the mass can be palpated and moves up and down when the patient swallows. When swallowing movements are not visible or felt on palpation, the patient has a grade 0 goiter. This is further confirmed by the absence of bruits when the neck is auscultated. The patient with a grade 2 goiter has a thyroid enlargement that is easily palpable and usually asymmetric. p 1266
What intervention is appropriate when caring for a patient during myxedema coma?
Replacing fluids with intravenous (IV) normal saline The patient who is experiencing myxedema coma should receive IV normal or hypertonic saline to replace fluids and correct dehydration. The patient will be intolerant to cold so the room temperature must be moderate. Warm blankets must be used to keep the patient warm. The patient's temperature and blood pressure must be monitored every hour; even a slight increase must be reported to the health care provider. p 1274
The nurse assigns an unlicensed assistive personnel (UAP) to monitor the temperature of a patient with Graves' disease. What does the nurse instruct the UAP to do?
Report even a 1-degree Fahrenheit increase in temperature immediately. The nurse should instruct the UAP to report even a 1-degree Fahrenheit increase in temperature immediately because any increase in temperature may indicate a rapid worsening of the patient's condition and the onset of a thyroid storm. The patient's temperature should be measured at least every 4 hours, documented, and reported to the nurse as soon as it is obtained.
