Recognize the Pattern
A 68-year-old patient reports increasing fatigue, constipation, and cold intolerance over the past several months. The nurse notes coarse hair, dry skin, delayed reflexes, HR 52/min, and weight gain despite a poor appetite.
This assessment finding should concern the nurse the most.
What is bradycardia (HR 52/min)?
A patient receiving levothyroxine reports chest pain shortly after the morning dose. The patient has a history of coronary artery disease.
The nurse's first action should be this.
What is assess the patient and notify the provider immediately?
A patient's laboratory results are:
These laboratory findings indicate that the nurse should anticipate administering this medication.
What is levothyroxine?
During morning assessment the nurse notes:
BP 126/78
HR 82
RR 18
Calcium 7.1
Tingling around the mouth
Mild nausea
This finding requires immediate follow-up.
What is tingling around the mouth (early hypocalcemia)?
The nurse enters the room and finds a patient with Addison disease stating,
"I stopped taking my hydrocortisone because I felt better."
This response by the nurse is most appropriate.
What is explain that corticosteroids should never be stopped abruptly because adrenal crisis can occur?
The nurse is caring for a patient with hypothyroidism who has become increasingly fatigued over the past several days. Assessment findings now include:
If the patient's condition continues to decline, this life-threatening complication is most likely to occur next.
What is myxedema coma?
A patient reports kidney stones, generalized bone pain, constipation, and depression. Laboratory results reveal a calcium of 11.9 mg/dL.
This complication places the patient at the greatest long-term risk.
What are pathologic fractures (or decreased bone density)?
A patient with newly diagnosed Graves disease has a heart rate of 138 beats/min, reports palpitations, and states, "I can't seem to calm down." The provider has prescribed propranolol, methimazole, and acetaminophen.
The nurse should implement this intervention first.
What is administer the prescribed propranolol?
A patient's laboratory results reveal:
The patient reports tingling around the mouth and muscle cramps.
These laboratory findings place the patient at greatest risk for this complication.
What is tetany (or laryngospasm/seizures)?
The nurse enters the room of a patient receiving treatment for hyperthyroidism and notes the following:
This assessment finding requires immediate follow-up.
What is the heart rate of 146/min?
The nurse is preparing to administer levothyroxine to a patient with hypothyroidism. The patient asks if it can be taken with breakfast and a daily calcium supplement.
This teaching point is most appropriate.
What is take levothyroxine on an empty stomach and separate it from calcium supplements by at least 4 hours?
The nurse is caring for a patient with Graves disease. During the shift the patient develops:
Without immediate intervention, this complication is most likely to develop next.
What is thyroid storm?
A patient with long-term prednisone therapy has gained 30 pounds, bruises easily, and has poor wound healing.
The nurse identifies this priority nursing problem.
What is risk for infection?
A patient with hypoparathyroidism begins complaining of tingling around the lips and fingers. The nurse observes carpal spasms while obtaining a blood pressure.
This is the nurse's priority action.
What is prepare to administer calcium while maintaining a patent airway?
A patient's laboratory results reveal:
The nurse identifies this organ system as being at the greatest risk for complications.
What is the renal (urinary) system?
The nurse is caring for a patient one day after a thyroidectomy. During assessment, the patient states, "My voice sounds funny," and the nurse observes:
This assessment finding is the priority concern.
What is the change in voice (hoarseness)?
A patient with Graves disease has been taking methimazole for three weeks and calls the clinic reporting a sore throat and fever.
The nurse should instruct the patient to do this immediately.
What is stop the medication and notify the healthcare provider immediately (to evaluate for agranulocytosis)?
The nurse is caring for a patient one day after a thyroidectomy. During assessment the patient reports tingling around the mouth and fingertips. Thirty minutes later the patient develops muscle twitching and carpal spasms.
If treatment is delayed, this complication is most likely to occur next.
What is laryngospasm (or airway compromise)?
A patient presents with tremors, anxiety, tachycardia, weight loss, heat intolerance, and insomnia.
This assessment finding requires immediate intervention.
What is tachycardia?
A patient with hyperparathyroidism reports severe flank pain and nausea. Laboratory results reveal a serum calcium level of 12.8 mg/dL.
This is the nurse's priority intervention.
What is begin hydration with IV fluids as prescribed and monitor urine output?
A patient's laboratory results are:
These laboratory findings require the nurse to anticipate administration of this medication.
What is hydrocortisone?
The nurse is caring for a patient with Cushing syndrome. Assessment findings include:
This assessment finding requires the nurse's immediate attention.
What is the skin tear with yellow drainage?
The nurse is preparing to administer calcium gluconate IV to a patient with symptomatic hypocalcemia.
This assessment should be completed before and during administration.
What is monitor the patient's cardiac rhythm (ECG)?
The nurse is caring for a patient with untreated hyperparathyroidism. Assessment findings include:
If the elevated calcium level is not corrected, this complication is most likely to occur next.
What are kidney stones (renal calculi)?
A patient with Addison disease has BP 82/46, HR 122, Na 121, K 6.4, glucose 48.
The nurse recognizes the patient is progressing toward this complication.
What is shock (or adrenal crisis)?
The nurse is caring for a patient admitted with Addison disease. During morning assessment, the patient is difficult to arouse and reports feeling "too weak to get out of bed." Assessment findings include:
This is the nurse's priority action.
What is begin rapid IV isotonic fluid replacement while preparing to administer IV hydrocortisone?
The nurse reviews the following laboratory results for a patient taking prednisone for several years:
These laboratory findings support this priority nursing problem.
What is risk for infection?
The nurse is assessing a patient with Addison disease who has received IV fluids and hydrocortisone for the past two hours. Which new finding would require the nurse to intervene immediately?
This assessment finding requires immediate follow-up.
What are peaked T waves with frequent PVCs?
A patient with Addison disease develops influenza with persistent vomiting and fever. The patient asks whether they should continue taking their prescribed hydrocortisone.
This is the most appropriate nursing response.
What is instruct the patient to follow their sick-day plan and increase corticosteroid dosing as prescribed while notifying their healthcare provider?
The nurse is caring for a patient with Addison disease who has experienced vomiting and diarrhea for two days. Current assessment findings include:
The nurse has notified the provider, but treatment has not yet begun.
If the patient's condition continues to deteriorate, this outcome is most likely to occur next.
What is circulatory shock?