NUS111: THYROID REVIEW
For a client with hyperthyroidism, treatment is most likely to include: A. a thyroid hormone antagonist. B. thyroid extract. C. a synthetic thyroid hormone. D. emollient lotions.
A. a thyroid hormone antagonist. RATIONALE Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? A. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test B. A decreased TSH level C. An increase in the TSH level after 30 minutes during the TSH stimulation test D. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay
A. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test RATIONALE In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
A nurse is collecting data from a client who is suspected of having an endocrine disorder and is scheduled for diagnostic testing that involves the use of a contrast medium. The nurse would inform the physician if the client stated which of the following? A. "My father had diabetes when he got older." B. "I have an allergy to shrimp and shellfish." C. "I take a multivitamin every day." D. "Years ago, I took a steroid for my asthma."
B. "I have an allergy to shrimp and shellfish." RATIONALE The statement about an allergy to shrimp and shellfish would alert the nurse to the possibility of an allergy to iodine, a component of contrast media. This information needs to be reported to the physician. Although information about a family history of diabetes would be important, it would have no effect on the diagnostic testing. Certain drugs can affect diagnostic testing, but a multivitamin probably would not be a problem. Use of steroids within the past 3 months, rather than several years ago, could impact the results of thyroid testing.
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply. A. A pulse rate slower than 90 bpm B. An elevated systolic blood pressure C. Muscular fatigability D. Weight loss. E. Intolerance to cold
B. An elevated systolic blood pressure C. Muscular fatigability D. Weight loss.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? A. Thyroid storm B. Myxedemic coma C. Addison's disease D. Acromegaly
B. Myxedemic coma RATIONALE Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A. Diabetic ketoacidosis B. Thyroid crisis C. Hypoglycemia D. Tetany
B. Thyroid crisis RATIONALE Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: A. dry, waxy swelling and abnormal mucin deposits in the skin. B. protruding eyes and a fixed stare. C. a wide, staggering gait. D. more than 10 beats/minute difference between the apical and radial pulse rates.
B. protruding eyes and a fixed stare. RATIONALE Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? A. Fatigue B. Dyspnea C. Weight loss D. Hair loss
C. Weight loss RATIONALE Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
When caring for a client who's being treated for hyperthyroidism, the nurse should: A. provide extra blankets and clothing to keep the client warm. B. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. C. balance the client's periods of activity and rest. D. encourage the client to be active to prevent constipation.
C. balance the client's periods of activity and rest. RATIONALE A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
A nurse is assisting a client with breakfast choices. What type of diet would the nurse recommend for a client with hyperthyroidism? A. Low carbohydrate, low protein B. High fat, high protein C. Low calorie, low protein D. High calorie, high protein
D. High calorie, high protein RATIONALE High-calorie, high-protein foods are encouraged for the client with hyperthyroidism becasue of the high metabolic rate. Foods and fluids are selected to replace fluid lost through diarrhea and diaphoresis and to control the diarrhea that results from increased peristalsis. Rapid movement of food through the GI tract may result in nutritional imbalance and further weight loss. High fat diet are not reccommened for clients. Clients with hyperthyroidism need protein and calories so low protein and low calorie diet is not a correct diet.
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? A. Methimazole (Tapazole) B. Thyroid USP desiccated (Thyroid USP Enseals) C. Liothyronine (Cytomel) D. Levothyroxine (Synthroid)
D. Levothyroxine (Synthroid) RATIONALE Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? A. Monitor laboratory values daily for elevated thyroid-stimulating hormone. B. Observe for swelling of the neck, tracheal deviation, and severe pain. C. Evaluate the quality of the client's voice postoperatively, noting any drastic changes. D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. RATIONALE Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.
A 50-year-old male patient has been admitted to the postsurgical unit from the PACU after having a total thyroidectomy. The nurse is now conducting an admission assessment and planning the patient's subsequent care. When providing this patient's care, the nurse should emphasize which of the following actions? A. Changing the patient's surgical dressing as ordered B. Monitoring and treating the patient's pain C. Maintaining the patient's fluid status D. Protecting the patient's airway
D. Protecting the patient's airway RATIONALE Hydration, pain control, and monitoring the patient's surgical dressing are all relevant components of the care of a patient who has undergone a thyroidectomy. However, protection of the airway is the priority action.
A middle-aged female patient has been diagnosed with hyperthyroidism and admitted to the hospital for treatment. When providing care for this patient, the nurse should prioritize: A. Vigilant monitoring of intake and output B. Teaching the patient about the pathophysiology of the disease C. Performing constant blood sugar monitoring D. Providing a calm, low-stimulation environment
D. Providing a calm, low-stimulation environment RATIONALE Patients with hyperthyroidism often present symptoms of nervousness. These patients are often emotionally hyperexcitable, irritable, and apprehensive. Consequently, a low-stimulation environment may be beneficial. This is likely a priority over teaching the patient about pathophysiology. Strict intake and output and glycemic monitoring are not normally necessary in the treatment of hyperthyroidism.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: A. exophthalmos and conjunctival redness. B. flushed, warm, moist skin. C. systolic murmur at the left sternal border. D. decreased body temperature and cold intolerance.
D. decreased body temperature and cold intolerance. RATIONALE Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.