Week 12 Sherpath: Thyroid and Adrenal Gland Disorders: Thyroid Storm, Myxedema Coma, and Adrenal Hormonal Secretion Disorders

Which criterion is used to determine thyroid storm scoring? Select all that apply. One, some, or all responses may be correct. A. Cardiac B. Gastrointestinal C. Thermoregulatory D. Ocular E. Psychiatric

A, B and C Cardiac Various parameters of three major body systems are used to screen for the presence of thyroid storm. They include the cardiac, gastrointestinal, and thermoregulatory systems. Gastrointestinal Various parameters of three major body systems, including the gastrointestinal system, are used to screen for the presence of thyroid storm. Thermoregulatory Various parameters of three major body systems, including the thermoregulatory system, are used to screen for the presence of thyroid storm.

Which body system is affected by myxedema coma? Select all that apply. One, some, or all responses may be correct. A. Integumentary B. Alimentary C. Cardiac D. Pulmonary E. Renal

A, B, C, D and E Integumentary The effects of myxedema are widespread and affect nearly every body system. Alimentary The effects of myxedema are widespread and affect nearly every body system. Cardiac The effects of myxedema are widespread and affect nearly every body system. Pulmonary The effects of myxedema are widespread and affect nearly every body system. Renal The effects of myxedema are widespread and affect nearly every body system.

Which condition is a clinical manifestation (sign or symptom) of thyroid storm? Select all that apply. One, some, or all responses may be correct. A. Tachycardia B. Nausea C. Chest pain D. Nervousness E. Diarrhea F. Psychosis

A, B, C, D, E and F Tachycardia Tachycardia is a sign of the increased metabolism of thyroid storm that can be recorded objectively. Nausea Nausea is a symptom of thyroid storm. Chest pain The experience of pain cannot be quantified, thus it is classified as a symptom of thyroid storm. Nervousness An emotional state is a symptom as it cannot be quantified when assessing for thyroid storm. Diarrhea Diarrhea is a gastrointestinal manifestation of thyroid storm. Psychosis Psychosis is a late sign of untreated thyroid storm.

Which percentage of the population is affected by Graves disease? A. 3% of women B. 5% of men C. 3.5% of the population D. 5% of the population

A. 3% of women Up to 3% of women suffer from Graves disease, making them at risk to develop thyroid storm.

Which condition would contribute to the development of Cushing syndrome? A. Adenoma B. Sarcoma C. Melanoma D. Glioblastoma

A. Adenoma A tumor of the adrenal gland that would alter the secretion of cortisol, resulting in Cushing syndrome.

Which method is used to reduce the hyperthermia of thyroid storm? A. Cooling blanket B. Aspirin C. Ibuprofen D. Convection

A. Cooling blanket A cooling blanket in conjunction with acetaminophen is the preferred method of fever control.

Which hormone is deficient with Addison disease? A. Cortisol B. Insulin C. T4 D. TSH

A. Cortisol Cortisol, as well as aldosterone, are deficient in Addison disease.

Which condition would contribute to secondary Cushing syndrome? A. Exogenous steroids B. Adenoma C. Pituitary tumor D. Hypothyroidism

A. Exogenous steroids Extended use and/or abrupt discontinuation of exogenous steroids may precipitate secondary Cushing syndrome.

Which substance is given to offset the hypermetabolism of thyroid storm? A. Glucose B. Salicylates C. Hypotonic crystalloids D. Hypertonic crystalloids

A. Glucose Hypermetabolism of thyroid storm rapidly depletes energy stores and must be replaced in the simplest form.

Which condition contributes to the development of thyroid storm? A. Graves disease B. Myxedema C. Hypothyroidism D. Hirsutism

A. Graves disease Graves disease is a condition that attacks the thyroid, causing it to secrete excess hormone. It is the primary cause of hyperthyroidism, which can lead to thyroid storm.

Which educational topic is directed at patient safety when discharged with thyroid storm-preventing medications? A. Orthostatic hypotension B. Medication compliance C. Agranulocytosis D. Reportable conditions

A. Orthostatic hypotension Beta-blockers are used to control heart rate. If there is a side effect of orthostatic hypotension, the patient could suffer a fall.

Which hormone is increased in patients with mxyedema? A. TSH B. T3 C. T4 D. Free T4

A. TSH Thyroid-stimulating hormone (TSH) is released to instruct the thyroid to secrete hormone. When it is elevated, the thyroid has become less responsive.

Which independent nursing action is appropriate for the care of the patient with myxedema coma? A. Warm blankets B. Thyroxine replacement C. Intubation D. Fluid replacement

A. Warm blankets Hypothermia is a significant concern. Retention of body heat is important and requires no interdisciplinary prescription.

Which patient statement would make the nurse suspect hyperthyroidism? Select all that apply. One, some, or all responses may be correct. A. "I just can't get warm!" B. "My blood sugar has been so high lately." C. "I've lost so much weight without trying!" D. "I must be going through menopause really early." E. "It's 74 degrees outside and I am sweating like a pig!"

B, C, D and E "My blood sugar has been so high lately." Hyperglycemia is characteristic of hyperthyroidism. "I've lost so much weight without trying!" Unexplained weight loss can be attributed to hyperthyroidism. "I must be going through menopause really early." Oligomenorrhea as opposed to menorrhagia is a sign of hyperthyroidism. "It's 74 degrees outside and I am sweating like a pig!" Heat intolerance is a classic indication of hyperthyroidism.

Which effect may myxedema have on the cardiac system? A. Tachycardia B. Cardiac tamponade C. Increased stroke volume D. Widened pulse pressure

B. Cardiac tamponade Accumulation of serous fluid in the pericardial sac from hypometabolism can result in cardiac tamponade.

Which nursing action is appropriate for the patient with myxedema coma? A. Hot water and soap bath daily B. Skin lotion C. Prone positioning D. Fluid restriction

B. Skin lotion Myxedema and hypothyroidism can produce rough, dry skin.

Which sign is a clinical manifestation of thyroid storm? A. Nausea B. Tachycardia C. Chest pain D. Nervousness

B. Tachycardia Tachycardia is a sign of increased metabolism of thyroid storm that can be recorded objectively, differentiating it from a symptom.

Which nursing responsibility is the most important when treating a patient with thyroid storm? A. Rehydration B. Temperature reduction C. Comfort D. Nutrition

B. Temperature reduction Reduction of hyperthermia is a top priority of care for the thyroid storm patient. By doing so, the metabolic demand is reduced.

Which score for the Thyroid Storm Diagnostic Criteria confirms the diagnosis of thyroid crisis? A. 30 B. 36 C. 47 D. 18

C. 47 A score greater than 45 confirms the condition of thyroid storm.

Which medication is the primary treatment for myxedema coma? A. Iodine B. Levofloxacin C. Levothyroxine D. Metoprolol

C. Levothyroxine Replacing thyroid hormone is vital in the treatment of hypothyroidism and myxedema coma.

Which patient statement would lead the nurse to suspect myxedema? A. "I must be going through menopause really early." B. "My blood sugar has been so high lately." C. "I've lost so much weight without trying!" D. "I can't get warm no matter what I do!"

D. "I can't get warm no matter what I do!" Hypothermia is a classic sign/symptom of myxedema.

Which pair of hormones are deficient in Addison's disease? A. Insulin and secretin B. T3 and T4 C. Free T3 and TSH D. Aldosterone and cortisol

D. Aldosterone and cortisol A reduction of aldosterone and cortisol results in Addison disease.

Which rationale best supports patient education? A. Legal protection B. Medication compliance C. Reduced dependence on provider D. Early diagnosis

D. Early diagnosis A well-educated patient and family will recognize the signs and symptoms of hypothyroidism earlier, thus preventing a decline into myxedema coma.

Which condition can be the result of a pheochromocytoma? A. Hypovolemia B. Hyponatremia C. Hyperkalemia D. Hypertension

D. Hypertension Pheochromocytoma causes significantly elevated blood pressure as a result of the excessive amount of catechol output.

Which medication reduces the amount of thyroid hormone produced? A. Iodine B. Metoprolol C. Verapamil D. Methimazole

D. Methimazole This medication blocks the synthesis of new thyroid hormone.