Chapter 66: Care of Patients with Problems of the Thyroid and Parathyroid GlandsTest Bank

MULTIPLE CHOICE

1.A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal thyroid-stimulating hormone (TSH) levels. Which is the nurses priority intervention?a.Administer levothyroxine (Synthroid).b.Administer propranolol (Inderal).c.Monitor the apical pulse.d.Assess for Trousseaus sign.

ANS:CThe clients laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the clients heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Synthroid is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseaus sign is a test for hypocalcemia.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)MSC:Integrated Process: Nursing Process (Implementation)

2.Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?a.You will have external beam radiation.b.No radiation is used for this scan.c.No special radiation precautions are needed.d.Your thyroid will be radioactive for weeks.

ANS:CThe radioactive iodine used in thyroid scans is of low intensity and has such a short half-life that the client is not considered to be a radiation hazard. Thus, no radiation precautions are necessary. The other statements are inaccurate.

DIF:Cognitive Level: Comprehension/UnderstandingREF:p. 1396TOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests)MSC:Integrated Process: Teaching/Learning

3.Which dietary modification does the nurse provide for a client with hyperthyroidism?a.Decreased calories and proteins and increased carbohydratesb.Elimination of carbohydrates and increased proteins and fatsc.Increased calories, proteins, and carbohydratesd.Supplemental vitamins and reduction of calories

ANS:CThe client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. The other modifications are inappropriate for a client with hyperthyroidism.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management)MSC:Integrated Process: Nursing Process (Implementation)

4.A client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the client is having side effects of this therapy?a.Blurred visionb.Increased thirst and urinationc.Increased sweating and diarrhead.Decreased attention span and insomnia

ANS:BLithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. The other choices are not specific to lithium.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)MSC:Integrated Process: Nursing Process (Evaluation)

5.A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. Which is the nurses best response?a.Iodine will help make the internal surgical environment sterile.b.It is given to stimulate the storage of excess thyroid hormones.c.This will replace the hormones you will lose after your operation.d.It will prevent excessive bleeding during surgery.

ANS:DIodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery. The other answers are not accurate.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)MSC:Integrated Process: Nursing Process (Implementation)

6.Twelve hours after a total thyroidectomy, the client develops stridor. Which is the nurses priority intervention?a.Reassure the client that the voice change is temporary.b.Document the finding and assess the client hourly.c.Hyperextend the clients neck and apply oxygen.d.Prepare for emergency tracheostomy and call the health care provider.

ANS:DStridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. The other choices do not address the emergency situation.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies)MSC:Integrated Process: Nursing Process (Implementation)

7.On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around his mouth. Which is the nurses priority intervention?a.Offer mouth care.b.Loosen the dressing.c.Assess Chvosteks sign.d.Assess the client hourly.

ANS:CNumbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvosteks sign and Trousseaus sign. Then the nurse should notify the provider. The other choices do not address the emergency situation.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)MSC:Integrated Process: Nursing Process (Analysis)

8.Which client statement alerts the nurse to the possibility of hypothyroidism?a.My sister has thyroid problems.b.I seem to feel the heat more than other people.c.Food just doesnt taste good without a lot of salt.d.I am always tired, even with 10 or 12 hours of sleep.

ANS:DClients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hyperthyroidism.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)MSC:Integrated Process: Nursing Process (Assessment)

9.A client has been diagnosed with hypothyroidism. Which medication is the nurse prepared to administer to treat the clients bradycardia?a.Atropine sulfateb.Levothyroxine sodium (Synthroid)c.Propranolol (Inderal)d.Epinephrine (Adrenalin)

ANS:BThe treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Inderal is a beta blocker and would be contraindicated for a client with bradycardia.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)MSC:Integrated Process: Nursing Process (Implementation)

10.A client has hypothyroidism. Which problem does the nurse address as a priority for this client?a.Heat intoleranceb.Body image problemsc.Depression and withdrawald.Obesity

ANS:CHypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The clients family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the clients environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)MSC:Integrated Process: Nursing Process (Analysis)

11.A client has hypothyroidism and has been started on levothyroxine (Synthroid). Which assessment finding leads the nurse to conclude that the treatment is effective?a.Thirst is recognized and the client drinks fluids appropriately.b.Weight has been the same for 3 weeks.c.Total white blood cell count is 6000 cells/mm3.d.Heart rate is 70 beats/min and regular.

ANS:DHypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a clients heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. The other assessment findings do not give any indication as to whether treatment is successful.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)MSC:Integrated Process: Nursing Process (Evaluation)

12.A client with hypothyroidism as a result of Hashimotos thyroiditis asks the nurse how long she will have to take thyroid medication. Which is the nurses best response?a.You will need to take the thyroid medication until the goiter is completely gone.b.Thyroiditis is cured with antibiotics. Then you wont need thyroid medication.c.Youll need thyroid pills for life because your thyroid wont start working again.d.When blood tests indicate normal thyroid function, you can stop the medication.

ANS:CHashimotos thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The other answers are incorrect.

DIF:Cognitive Level: Comprehension/UnderstandingREF:p. 1405TOP:Client Needs Category: Health Promotion and Maintenance (Self-Care)MSC:Integrated Process: Communication and Documentation

13.The nurse is reviewing client medical histories. Which client is at greatest risk for hyperparathyroidism?a.Client with pregnancy-induced hypertensionb.Client receiving dialysis for end-stage kidney diseasec.Older adult client with moderate heart failured.Older adult client on home oxygen therapy

ANS:BClients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. The other factors do not place a client at higher risk for hyperparathyroidism.

DIF:Cognitive Level: Knowledge/RememberingREF:Table 66-3, p. 1406TOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)MSC:Integrated Process: Nursing Process (Assessment)

14.A client has hyperparathyroidism. Which intervention is the priority for the nurse to add to the clients plan of care?a.Instruct the client to place both hands behind the neck when moving.b.Use a lift sheet to assist the client with position changes.c.Instruct the client to use a soft-bristled toothbrush.d.Strain all urine for at least 24 hours and send stones to the laboratory.

ANS:BHyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Supporting the neck with movement and using a soft toothbrush are not needed for this client.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)MSC:Integrated Process: Nursing Process (Implementation)

15.When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the clients hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition?a.Serum potassium, 2.9 mEq/Lb.Serum potassium, 5.8 mEq/Lc.Serum sodium, 122 mEq/Ld.Serum calcium, 6.9 mg/dL

ANS:DHypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseaus sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyperkalemia, and hyponatremia.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values)MSC:Integrated Process: Nursing Process (Analysis)

16.The client is receiving methimazole (Tapazole). Which statement by the client indicates good understanding of teaching regarding this medication?a.If I become pregnant, I need to notify my health care provider immediately.b.Liver problems can occur with this drug so I need to report jaundice.c.I will take my pulse daily, and if it is too fast, I will call my provider.d.This medication may cause dyspnea or vertigo. I will be careful with activity.

ANS:AMethimazole can cause birth defects, and clients should not take it if they are pregnant. Liver problems can occur with propylthiouracil (PTU). The client does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of methimazole.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Health Promotion and Maintenance (Self-Care)MSC:Integrated Process: Nursing Process (Evaluation)

17.A client has diabetes mellitus. Her daughter has recently been diagnosed with Graves disease. The client asks the nurse if she is responsible for the fact that her daughter has Graves disease. Which is the best response of the nurse?a.No connection is known between Graves disease and diabetes, so you can be certain that the fact that you have diabetes did not cause your daughter to have Graves disease.b.An association has been noted between Graves disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves disease.c.Graves disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes.d.Unfortunately, Graves disease is associated with diabetes, and your diabetes could have led to your daughter having Graves disease.

ANS:BAn association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic and the clients diabetes did not cause her daughters Graves disease. The other statements are inaccurate.

DIF:Cognitive Level: Comprehension/UnderstandingREF:p. 1394TOP:Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)MSC:Integrated Process: Teaching/Learning

18.The nurse is assessing a client with Graves disease and finds that the clients temperature has risen 1 F. Before notifying the health care provider, which action by the nurse takes priority?a.Turn the lights down in the clients room and shut the door.b.Call for an immediate electrocardiogram (ECG).c.Calculate the clients apical-radial pulse deficit.d.Administer a dose of acetaminophen (Tylenol).

ANS:AA temperature increase of 1 F may indicate the development of thyroid storm, and the provider needs to be notified. Before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities)MSC:Integrated Process: Nursing Process (Implementation)

19.A client has undergone a complete thyroidectomy. Which statement by the client indicates that further instruction is needed?a.I may need calcium replacement after surgery.b.After surgery, I wont need to take thyroid medication.c.Ill need to take thyroid hormones for life.d.I can receive pain medication if I feel that I need it.

ANS:BAfter the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery and can receive pain medication postoperatively.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management)MSC:Integrated Process: Nursing Process (Evaluation)

20.A client being treated for hypothyroidism has been admitted for pneumonia. Which activity does the nurse include as a priority in this clients care plan?a.Monitor the clients IV site every shift.b.Administer acetaminophen (Tylenol) for fever.c.Ensure that working suction equipment is in the room.d.Assess vital signs every 4 hours.

ANS:CA client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction is available in the clients room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)MSC:Integrated Process: Nursing Process (Analysis)

MULTIPLE RESPONSE

1.A client has been admitted with hypoparathyroidism. The clients serum laboratory values are as follows: calcium, 7.2 mg/dL; sodium, 144 mEq/L; magnesium, 1.2 mEq/L; potassium, 5.7 mEq/L. Which medications does the nurse anticipate administering? (Select all that apply.)a.Potassium chloride orallyb.Calcium chloride IVc.3% NS IV solutiond.50% magnesium sulfatee.Calcitriol (Rocaltrol) orally

ANS:B, DThe client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The clients sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is available, so calcitriol is not needed.

DIF:Cognitive Level: Application/Applying or higherREF:N/ATOP:Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)MSC:Integrated Process: Nursing Process (Analysis)