Case Study
The client's presenting vital signs:
Given the initial history and vital signs, what other questions should the nurse ask?
"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?”
Based on the client's history and presenting symptoms, which additional diagnostic tests does the nurse anticipate the HCP to order?(Select all that apply. One, some, or all options may be correct.)
CBC with differential
Blood Chemistries
TSH and free T4
Chest X-ray (CXR)
Arterial blood gases (ABG's)
CBC with differential
Blood Chemistries
TSH and free T4
Which statement best describes hypothyroidism?
A condition in which the thyroid gland produces excessive thyroid hormones, leading to increased metabolism.
A chronic condition caused by deficient production of thyroid hormones, resulting in a slowed metabolic rate.
An acute adrenal disorder caused by insufficient cortisol and aldosterone production.
A complication of diabetes mellitus that results in severe hyperglycemia and ketoacidosis.
A chronic condition caused by deficient production of thyroid hormones, resulting in a slowed metabolic rate.
Which information in the client's history would be of concern to the nurse related to the use of levothyroxine?
Select all that apply
The client has an allergy to nonsteroidal anti-inflammatories (NSAID) medications.
The client eats her last meal of the day around 7:00 p.m.
The client takes a daily calcium supplement.
The client prefers to take her medications with a full glass of water.
The client takes a daily calcium supplement.
Calcium should be taken at least four hours after the Levothyroxine dose to prevent interference with absorption.
What is Myxedema crisis?
A life-threatening emergency caused by severe hypothyroidism, leading to hypothermia, bradycardia, hypotension, and altered mental status.
A complication of hyperthyroidism, marked by severe hypertension, tachycardia, and hyperthermia.
An acute adrenal insufficiency that occurs after abrupt withdrawal of corticosteroids.
A metabolic complication of diabetes mellitus resulting in hyperglycemia, ketonuria, and metabolic acidosis.
A life-threatening emergency caused by severe hypothyroidism, leading to hypothermia, bradycardia, hypotension, and altered mental status.
The client has signed the consent for the radioactive iodine uptake test. What are the most important assessments for the nurse to obtain prior to the test? (Select all that apply. One, some, or all options may be correct.)
Ask if the client has been taking any OTC medications such as cough syrups?
Determine if the client has eaten in the past 4 hours.
Investigate the client's use of over the counter (OTC) multivitamin and herbal products.
Find out if the client has ever had a reaction to a bee sting.
Assess the client's history for allergic reaction to peanuts.
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.
Find out if the client has ever had a reaction to a bee sting.
Based on the HCP's assessment and interpretation of the diagnostics, the client is diagnosed with hypothyroidism. Which other lab should be monitored after the diagnosis of hypothyroidism is confirmed?
Albumin
Triglycerides and cholesterol
PT/PTT
Uric acid
Triglycerides and cholesterol
The client asks the nurse how she got this disease. Which explanation by the nurse is accurate?
Hypothyroidism is inherited from parents.
Viral infections cause hypothyroidism.
A bacterial infection causes hypothyroidism.
An autoimmune dysfunction causes thyroid dysfunction.
An autoimmune dysfunction causes thyroid dysfunction.
The client tells the nurse she has a hard time taking medications regularly. She asks how long she will need to take the levothyroxine. 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.
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 sodium chloride at prescribed rate.
Cover the client with warm blankets.
Assess cardiac system.
Start an IV of sodium chloride at prescribed rate.
Cover the client with warm blankets.
On the fourth week visit, the nurse recognizes that the client is improving when she assesses which of the following? Select all that apply.
The client has lost 5 pounds.
The client reports that she has begun walking around the track twice a week.
The client's heart rate over the past weeks has range 46 to 52 beats/min.
The client's temperature over the past weeks has range 94° to 95° F orally.
The client reports that her bowel habits have returned to normal.
The client has lost 5 pounds.
The client reports that she has begun walking around the track twice a week.
The client reports that her bowel habits have returned to normal.
The client's dose of levothyroxine is increased, and arrangements are made for a home health nurse to assess her weekly for 4 weeks. During one of the home visits, the client talks with the nurse about her dietary intake. She said she has been reading online about her diagnosis. The client asks the nurse if she should take supplemental iodine tablets as a preventive measure for her hypothyroidism.
Question 23 of 25
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.
Which symptoms are the client with hypothyroidism most likely to exhibit? (Select all that apply. One, some, or all options may be correct.)Select all that apply.
Tachycardia and palpitations
Somnolence and fatigue
Coarse dry skin
Somnolence and cold intolerance
Diarrhea and weight loss
Somnolence and fatigue
Coarse dry skin
Somnolence and cold intolerance
Prior to the administration of each dose of levothyroxine, it is important to obtain which assessments? Select all that apply
Administer the medication prior to eating breakfast.
Record blood glucose.
Ensure that the heart rate is less than 100.
Record intake for the past 12 hours.
Assess the client's bowel sounds.
Administer the medication prior to eating breakfast.
Ensure that the heart rate is less than 100.
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
Case Outcome
The client continues to improve. At her six week follow-up, she regains a euthyroid state with her adjusted dosage of levothyroxine. Her TSH levels are within normal limits, and she remains on a constant dose of thyroid medication without any further problems. She reports feeling more like her old self. She continues to have routine examinations and lab tests at scheduled intervals with the primary HCP.
Good work team!!
At the two week visit, the client and the nurse have more discussions about her dietary intake. The nurse knows that the client understands her dietary needs when she 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."
Which approach by the nurse describes the action of the levothyroxine?
Blocks the production of thyroid hormone.
Increases fat, protein, carbohydrate metabolism.
Decreases the size of the thyroid gland.
Decreases the blood flow to the thyroid gland.
Increases fat, protein, carbohydrate metabolism.
Which behavior indicates to the nurse that the client understands the instructions related to the new medication?
The client selects menu choices that include several low-fat, high-protein products.
The client states to the nurse that she will only have to get a refill of the medication when her symptoms don’t subside.
The client states that she will need to notify the HCP of any chest pain.
The client demonstrates how to check her temperature using a digital thermometer.
The client states that she will need to notify the HCP of any chest pain.
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.