Thyroid Disorders

Eugena tells the nurse she has a hard time taking medications regularly. She asks how long she will need to take the Synthroid. What is the nurse's best response? The HCP will let you know when it is time to stop the medication. You will be able to stop the medicine in the next four to six months. The HCP will stop the medication when TSH level returns to normal. You will need to take this medication for the remainder of your life.

You will need to take this medication for the remainder of your life. This medication is a replacement hormone and will need to be taken for life.

At the two week visit, Eugena and the nurse have more discussions about her dietary intake. The nurse knows that Eugena understands her dietary needs when Eugena makes which statement? "Foods that I should include in my diet include tuna, yogurt, and macaroni." "I will need to avoid foods that contain rye, barley, wheat and oats." "Foods that contain lactose will aggravate my disease process." "My diet should consist of non-spicy foods, minimal use of dairy products, and low roughage."

"Foods that I should include in my diet include tuna, yogurt, and macaroni." All of these foods are good sources of iodine.

Eugena's presenting vital signs: Temperature: 96.0° F (35.6° C) Pulse: 52 beats/min RR: 16 breaths/min Blood pressure: 140/80 mmHg Given the initial history and vital signs, what other questions should the nurse ask? (Select all that apply.) "Have you had any changes in your bowel habits?" "Have you noticed an increase in urinary frequency?" "Do you still feel sleepy when you wake up in the mornings despite getting a good night's sleep?" "Have you noticed any changes in your hair or nails?" "Do you think your weight gain is because you eat too much?"

"Have you had any changes in your bowel habits?" "Do you still feel sleepy when you wake up in the mornings despite getting a good night's sleep?" "Have you noticed any changes in your hair or nails?" Hypothyroidism can cause constipation. Hypothyroidism can cause sleep disturbances. Hypothyroidism can cause hair loss and brittle nails.

Eugena is discharged with instructions to return for a follow-up appointment in 6 weeks. After three days, Eugena calls the clinic and tells the nurse that she is afraid of getting sick again. She states, "What if this happens again? I stay awake at night afraid I will get sick again." 19. Which is the best response by the nurse? "Why do you think this will happen again?" "I will get you some sleep medication." "What you experienced is not uncommon." "It sounds like that was a very frightening experience for you."

"It sounds like that was a very frightening experience for you." The best response is to acknowledge and support Eugena's fears and concerns. This is an open-ended statement that will encourage Eugena to continue to express her fears.

Medical treatment for hypothyroidism is based on replacement therapy. The HCP will monitor Eugene's goiter for now. The primary medication used to treat hypothyroidism is levothyroxine sodium (Synthroid). The HCP prescribes 1.7 mcg/kg body weight/day. Eugena's weight is 150 lbs. What is Eugene's daily dose of medication? (Enter numerical value only. If rounding is necessary, round to the whole number.)

116

Eugena reports to the nurse that she took an antidepressant for several months and because of how she's feeling, she'd like to restart her medication. Which is the most important advice by the nurse? Advise the client that it is ok to restart the antidepressant medication. Ask Eugena if she took the medication at night or in the am. Advise Eugena to check with the HCP first. Encourage Eugena to seek counseling for any depression she is experiencing.

Advise Eugena to check with the HCP first. Sedatives can increase the sensitivity to hormone replacement therapy. These medications should only be used if approved by the HCP.

Eugena also panics and admits to the nurse that she can't remember if she took her pill this morning. It is about 2 pm in the afternoon. Which information is important for the nurse to provide to the client? Instruct the client to check her heart rate and take the pill if her HR is greater than 100 beats/min. Take two pills tomorrow. Take the medication with dinner. Advise the client that the HCP will be notified and asked to call her with further instruction.

Advise the client that the HCP will be notified and asked to call her with further instruction.

Which explanation by the nurse is accurate? Hypothyroidism is inherited from parents. Viral infections cause hypothyroidism. An autoimmune dysfunction causes thyroid dysfunction. A bacterial infection causes hypothyroidism.

An autoimmune dysfunction causes thyroid dysfunction. The most common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimoto's disease) in which the immune system attacks the thyroid. More than 95% of patients either have primary or thyroidal hypothyroidism which refers to dysfunction of the thyroid itself.

Upon admission, the nurse should give the highest priority to meeting which need of a client who is brought to the ED with Myxedema crisis? (Select all that apply.) Assess cardiac system. Insert a Foley catheter Ask about current immunizations and medications. Start an IV of Normal Saline at prescribed rate. Cover the client with warm blankets.

Assess cardiac system. Myxedema crisis is life threatening. It is imperative to monitor for circulatory collapse Start an IV of Normal Saline at prescribed rate. This action is priority to prevent circulatory collapse. Cover the client with warm blankets. Hypothermia is a common symptom with myxedema crisis.

Based on Eugena's history and presenting symptoms, which additional diagnostic tests does the nurse anticipate the HCP to order? (Select all that apply.) CBC with differential. Blood Chemistries. TSH and free T4. Chest X-ray (CXR). Arterial blood gases (ABG's).

CBC with differential. The HCP needs to rule out other possible causes of Eugena's symptoms which could include anemia or an infection. Blood Chemistries. Chemistries would be needed to evaluate the patient's electrolyte and fluid status. TSH and free T4. These indicate the functioning or non-functioning of the thyroid gland.

Which symptoms are the client with hypothyroidism most likely to exhibit? (Select all that apply.) Tachycardia and palpitations. Diarrhea and weight loss. Coarse dry skin. Somnolence and cold intolerance. Somnolence and fatigue.

Coarse dry skin. This is a manifestation of hypothyroidism. Somnolence and cold intolerance. These are common in hypothyroidism. Somnolence and fatigue. Hypothyroidism generally causes an individual to have decreased initiative, somnolence, slowed speech, fatigue and lethargy.

With early recognition and intervention, Eugena only spends two nights in the hospital and recovers quickly, but she is concerned about this event occurring again. She asks what causes this condition. 18. What information should the nurse provide as a potential cause of a myxedema crisis? Contracting the flu. The stress of continuing school. Working full time. Failure to lose weight.

Contracting the flu. Viral infections can be a trigger for a myxedema crisis. Other triggers include the use of drugs (such as opioids, tranquilizers and barbiturates), exposure to cold, and trauma.

The home health nurse is developing a plan of care with Eugena until the new dose of levothyroxine controls her symptoms. 22. Which diagnosis would be included in the plan of care? Hyperthermia. Decreased cardiac output. Altered nutrition, less than body requirements. Diarrhea.

Decreased cardiac output. Decreased heart rate and force of contraction can lead to symptoms of diminished cardiac output

Prior to the administration of each dose of Synthroid, it is important to obtain which assessments? (Select all that apply.) Ensure that Eugena's heart rate is less than 100. Administer the medication prior to Eugena eating breakfast. Record Eugena's blood glucose. Record Eugena's intake for the past 12 hours. Assess Eugena's bowel sounds.

Ensure that Eugena's heart rate is less than 100. If the heart rate is 100 or greater, the medication should be held and the HCP should be notified. Administer the medication prior to Eugena eating breakfast. The medication should be administered on an empty stomach prior to breakfast

Which information in Eugena's history would be of concern to the nurse related to the use of Synthroid? (Select all that apply.) Eugena has an allergy to aspirin. Eugena enjoys strawberries, peaches and pears. Eugena takes a daily calcium supplement. Eugena eats her last meal of the day around 7 pm. Eugena prefers to take her medications with tea or lemonade.

Eugena has an allergy to aspirin. Synthroid contains tartrazine, which can cause an allergic reaction in patients who have sensitivity to aspirin. Eugena enjoys strawberries, peaches and pears. Consumption of these foods can inhibit thyroid secretion. Other foods that can inhibit thyroid secretion include kale, cabbage, turnips, spinach, brussel sprouts, cauliflower, radishes, and peas. Eugena takes a daily calcium supplement. Calcium should be taken at least four hours after the Synthroid dose to prevent interference with absorption. Eugena prefers to take her medications with tea or lemonade. Synthroid should be taken on an empty stomach in the morning with a full glass of water.

On the fourth week visit, the nurse recognizes that Eugena is improving when she assesses which of the following? (Select all that apply.) Eugena has lost 5 pounds. Eugena reports that she has begun walking around the track twice a week. Eugena's HR over the past weeks has range 46 to 52 beats/min. Eugena's temperature over the past weeks has range 94° to 95° F orally. Eugena reports that her bowel habits have returned to normal.

Eugena has lost 5 pounds. Weight gain is a symptom of hypothyroidism. Weight loss is a sign of improvement of thyroid function. Eugena reports that she has begun walking around the track twice a week. Increased energy level is sign of improved thyroid function. Hypothyroidism causes decreased energy levels Eugena reports that her bowel habits have returned to normal. Hypothyroidism causes constipation. As the thyroid improves, bowel habits should return to the client's baseline.

Which behavior indicates to the nurse that Eugena understands the instructions related to her new medication? Eugena selects menu choices that include several low-fat, high-protein products. Eugena states to the nurse that she will only have to get a refill of the medication when her symptoms don't subside. Eugena states that she will need to notify the HCP of any chest pain. Eugena demonstrates how to check her temperature using a digital thermometer.

Eugena states that she will need to notify the HCP of any chest pain. Chest pain can indicate a problem with the cardiovascular system. Clients should be instructed to monitor their pulse and to report tachycardia, an irregular pulse, or palpitations to the HCP.

Eugena is scheduled for a radioactive iodine uptake test. This test is used to measure the rate of iodine uptake by the thyroid gland. She is also scheduled for a thyroid scan. After the consent form is signed, what assessment data are most important for the nurse to obtain prior to the radioactive iodine uptake test? (Select all that apply.) Find out if the client has ever had a reaction to a bee sting. Ask if the client has been taking any OTC medications such as cough syrups? Investigate the client's use of over the counter (OTC) multivitamin and herbal products. Determine if the client has eaten in the past 4 hours. Assess the client's history for allergic reaction to peanuts.

Find out if the client has ever had a reaction to a bee sting. Ask if the client has been taking any OTC medications such as cough syrups? Investigate the client's use of over the counter (OTC) multivitamin and herbal products. Allergic reactions to bee stings and shell fish should be assessed. Many OTC cough medications contain some iodine. There may not be enough to interfere with the test results, but the information needs to be assessed.. Many OTC multivitamins contain some iodine. There may not be enough to interfere with the test results, but the information needs to be assessed.

At her six week appointment, Eugena complains of fatigue, some increasing constipation, and weight gain. Her serum TSH level is still elevated. Based on the clinical manifestations and lab results, what change in medication should the nurse anticipate? Increase her dose of levothyroxine. Decrease her dose of levothyroxine. Discontinue the levothyroxine. Change to a new hormone replacement medication.

Increase her dose of levothyroxine. Eugena is still exhibiting symptoms of hypothyroidism, which will require an increase in her dose of levothyroxine. Her dose will be increased as needed.

Which approach by the nurse describes the action of the levothyroxine (Synthroid) to Eugena? Decreases the size of the thyroid gland. Blocks the production of thyroid hormone. Increases fat, protein, carbohydrate metabolism. Decreases the blood flow to the thyroid gland.

Increases fat, protein, carbohydrate metabolism. The action of levothyroxine is the same as endogenous thyroid hormone. The drug increases the metabolic rate (increased oxygen consumption, respiration and heart rate) and increases the rate of fat, protein, and carbohydrate metabolism. It promotes growth and maturation.

Eugena has been doing well with her medication regime at home. She has been on the Synthroid about 3 weeks, and she is continuing to work and trying to finish the current semester of school. She has a follow up appointment in 6 weeks with her HCP. During week four, Eugena begins to feel bad. She has a cough and a low grade fever. She treats her symptoms with an OTC medication, but her symptoms worsen. She is diagnosed with the flu and after 3 days she still feels bad. She calls a colleague to take her to the local emergency department (ED). Upon arrival, Eugena is lethargic but arousable. She tells the nurse she was recently diagnosed with hypothyroidism. 15. Based on the diagnosis of hypothyroidism, what condition does the nurses suspect Eugena is experiencing? Graves' Disease. Myxedema crisis. Thyroid storm. Addison disease.

Myxedema crisis. Myxedema is a rare life threatening condition that is a decompensated state of severe hypothyroidism

Other therapies for myxedema crisis include maintaining a patent airway, administration of IV levothyroxine sodium, IV glucose, and IV corticosteroids. Nurses should continue to monitor the vital signs, especially the blood pressure, heart rate and temperature hourly until stable. Eugena's blood gases are as follows: pH: 7.33 pCO2: 50 PaO2: 99 HCO3: 24 Based on the nurse's assessment of these labs which finding accurately describes the results? Metabolic alkalosis. Respiratory alkalosis. Metabolic acidosis. Respiratory acidosis.

Respiratory acidosis

Eugena's dose of levothyroxine (Synthroid) is increased, and arrangements are made for a home health nurse to assess her weekly for 4 weeks. During one of the home visits, Eugena talks with the nurse about her dietary intake. She said she has been reading online about her diagnosis. Eugena asks the nurse if she should take supplemental iodine tablets as a preventive measure for her hypothyroidism. 23. Which is the best response for the nurse when instructing the client about the use of supplemental iodine? Iodine tablets can be purchased over the counter with directions for dosing on the bottle. Increase intake of red meat to twice a week. The use of salt with iodine and a well-balanced diet should provide adequate iodine. The information found online is incorrect.

The use of salt with iodine and a well-balanced diet should provide adequate iodine. Moderate salt intake with a proper diet provides adequate iodine intake.

Which instructions should the nurse include when teaching Eugena about Synthroid? (Select all that apply.) This medication should be is taken twice a day with food. This medication requires periodic lab work to monitor levels. Report chest pain, a rapid heartbeat, or increased nervousness to the HCP. Wear a medical alert bracelet. When refilling this medication, ask the pharmacist for the least expensive brand of the medication.

This medication requires periodic lab work to monitor levels. This is a true statement. TSH levels are monitored periodically (usually every 4 to 6 weeks) to monitor levels and adjust medication dose accordingly. Report chest pain, a rapid heartbeat, or increased nervousness to the HCP. These are signs/symptoms that should be reported to the HCP. These are symptoms that could indicate an adverse reaction. Wear a medical alert bracelet. This is an important safety factor for the client.

Thyroid scans are one means of evaluating the thyroid gland for presence of a nodule. Scanning also demonstrates the size, shape, function, and position of the thyroid gland. Radioactive iodine is administered PO or parenterally, and the uptake of the iodine by the thyroid gland is measured. Clients with hypothyroidism will demonstrate a decreased uptake of the radioactive iodine. Further physical examination reveals a slightly overweight female with a BMI of 27. While assessing her thyroid, the nurse finds a goiter. Goiter is the term for an enlarged thyroid gland. Depending on the cause of the hypothyroidism, the client may have a goiter. A goiter can also be present with hyperthyroidism. Eugena's lab result indicate mild anemia and a TSH that is 20 (normal is 0.5 to 5.0 microunits/mL). She asks "How did I get this disease?" Based on the results of all the diagnostic test, Eugena is diagnosed with hypothyroidism. Which other lab should be monitored after the diagnosis of hypothyroidism is confirmed? PT/PTT. Triglycerides and cholesterol. Albumin. Uric acid.

Triglycerides and cholesterol. Hypothyroidism can cause increased triglyceride and cholesterol levels, leading to coronary atherosclerosis.