thyroid
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? -Calcium gluconate -Potassium chloride -Sodium bicarbonate -Sodium phosphorus
Calcium gluconate Explanation: Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
The primary function of the thyroid gland includes which of the following? -Control of cellular metabolic activity -Facilitation of milk ejection -Reabsorption of water -Reduction of plasma level of calcium
Control of cellular metabolic activity Explanation: The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
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: -dry, waxy swelling and abnormal mucin deposits in the skin. -protruding eyes and a fixed stare. -a wide, staggering gait. -more than 10 beats/minute difference between the apical and radial pulse rates.
protruding eyes and a fixed stare. Explanation: 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.
A nurse should expect a client with hypothyroidism to report: -increased appetite and weight loss. -puffiness of the face and hands. -nervousness and tremors. -thyroid gland swelling.
puffiness of the face and hands. Explanation: Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? -Hypothyroidism -Hyperthyroidism -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -Diabetes insipidus (DI)
Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
The most common type of goiter is caused by lack of which of the following? -Iodine -Calcium -Potassium -Sodium
Iodine Explanation: The most common type of goiter is often encountered in geographic regions where there is lack of iodine. If too little iodine exists, the level of thyroxine will decrease, causing the stimulation of thyroid-stimulating hormone (TSH) from the anterior pituitary.
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? -Methimazole (Tapazole) -Thyroid USP desiccated (Thyroid USP Enseals) -Liothyronine (Cytomel) -Levothyroxine (Synthroid)
Levothyroxine (Synthroid) Explanation: 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.
Which intervention is the most critical for a client with myxedema coma? -Administering an oral dose of levothyroxine (Synthroid) -Warming the client with a warming blanket -Measuring and recording accurate intake and output -Maintaining a patent airway
Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones? -Propranolol -Dexamethasone -Potassium Iodide -Methimazole
Methimazole Explanation: Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.
A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? -Thyroid storm -Myxedema coma -Diabetes insipidus -Syndrome of inappropriate antidiuretic -hormone (SIADH)
Myxedema coma Explanation: Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? -Exophthalmos -Thyroid storm -Myxedema coma -Tibial myxedema
Myxedema coma Explanation: Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? -Thyroid storm -Myxedemic coma -Addison's disease -Acromegaly
Myxedemic coma Explanation: 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.
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? -Monitor laboratory values daily for elevated thyroid-stimulating hormone. -Observe for swelling of the neck, tracheal deviation, and severe pain. -Evaluate the quality of the client's voice postoperatively, noting any drastic changes. -Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Explanation: 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.
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? -Levothyroxine -Spironolactone -Propylthiouracil -Propranolol
Propylthiouracil Explanation: Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? -Stimulate more hormones using the negative feedback system -Stimulate more hormones using the positive feedback system -Produce a new hormone to try and regulate the thyroid function -Be unable to perform in response to low levels of thyroid hormone.
Stimulate more hormones using the negative feedback system Explanation: Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? -Symptoms of acute coronary syndrome -Dietary intake of foods with saturated fats -Symptoms of pneumonia -Heat intolerance
Symptoms of acute coronary syndrome Explanation: The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: -iodine and thyroid-stimulating hormone (TSH). -thyrotropin-releasing hormone (TRH) and TSH. -TSH, triiodothyronine (T3), and calcitonin. -T3, thyroxine (T4), and calcitonin.
T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? -Heart rate of 62 -Blood pressure 90/58 mm Hg -Oxygen saturation of 96% -Temperature of 102ºF
Temperature of 102ºF Explanation: Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.
For a client with hyperthyroidism, treatment is most likely to include: -a thyroid hormone antagonist. -thyroid extract. -a synthetic thyroid hormone. -emollient lotions.
a thyroid hormone antagonist. Explanation: 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.
The nurse is performing a physical examination on a client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland? -muscle twitching -cataracts -cold intolerance -shortness of breath
cold intolerance Explanation: The thyroid releases hormones that regulate the body's metabolic rate. During the health history, the nurse asks the client about changes in weight and appetite, bowel movements, heart rate and respiration, any marked tremors, nervousness, excitability, apprehension or impaired memory, decreased initiative, and slow thought processes. The nurse also asks about changes in the client's tolerance to heat and cold as well as excessive sweating, feeling very cold, lethargy or apathy, and changes in hair and skin. Muscle twitching, shortness of breath, and formation of a cataract are symptoms of parathyroid dysfunction.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: -thyroid storm. -cretinism. -myxedema coma. -Hashimoto's thyroiditis.
myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
