Thyroid
The nurse should assess for an enlarged thyroid by palpating which area?
A. Anterior neck
B. Supraclavicular
C. Mid-sternum
D. Submandibular
A. The thyroid gland is located in the neck in front of the trachea. It is not located in the submandibular, midsternal, or supraclavicular areas.
You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient?*
A. Fluid volume overload
B. Fluid volume deficient
C. Acute pain
D. Impaired skin integrity
A. Fluid volume overload
When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect:
a. a blood pressure of 130/70 mm Hg.
b. a blood glucose level of 130 mg/dl.
c. bradycardia.
d. a blood pressure of 176/88 mm Hg.
D.
Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options.
A female client has a serum calcium level of 7.2 mg/dl (reference range: 8.5 - 10.5mg/dL). During the physical examination, nurse Noah expects to assess:
a. Trousseau's sign.
b. Kernig's sign.
c. Tinnel's sign.
d. Phalen's sign.
A.
This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.
A client with a history of cardiovascular disease, who is taking a thyroid hormone, reports chest pain. What is the nurse’s best action?
A. Administer the next does of thyroid hormone.
B. Recommend increasing the next dose of thyroid hormone.
C. Reassure the client that this symptom resolves after several weeks of therapy.
D. Notify the health care provider.
D. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the client may require a reduction in the dosage of the thyroid hormone.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
A. exophthalmos and conjunctival redness.
B. flushed, warm, moist skin.
C. systolic murmur at the left sternal border.
D. decreased body temperature and cold intolerance.
D. decreased body temperature and cold intolerance.
Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly “water” weight. In addition, they report the patient hasn’t been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient’s HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?
A. SIADH
B. Diabetes Insipidus
C. Addison's Disease
D. Fluid Volume Deficient
A. SIADH
The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess?
A. Moon face, buffalo hump, and hyperglycemia
B. Hirsutism, fever, and irritability
C. Bronze pigmentation, hypotension, and anorexia
D. Tachycardia, bulging eyes, and goiter
C. Bronze pigmentation, hypotension, and anorexia
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?
A. Monitor laboratory values daily for elevated thyroid-stimulating hormone.
B. Observe for swelling of the neck, tracheal deviation, and severe pain.
C. Evaluate the quality of the client's voice postoperatively, noting any drastic changes.
D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
D. 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 providing education to a client newly prescribed propylthiouracil (PTU). What information should the nurse provide about the drug’s primary mode of action?
A. Destroys part of the thyroid gland
B. Inhibits production of thyroid hormone
C. Suppresses the anterior pituitary hormones
D. Stimulates the thyroid cells
B. Inhibits production of thyroid hormone
The thioamide drugs inhibit synthesis of thyroid hormone. Propylthiouracil does not destroy part of the thyroid gland. Propylthiouracil does not suppress the anterior pituitary hormones. Propylthiouracil does not stimulate the thyroid cells.
A pregnant client asks about the safety of taking thyroid hormone replacement drugs during her pregnancy. What is the nurse’s best response?
A. "Continue thyroid medication only if you have a history of heart disease."
B. "Thyroid hormones are pregnancy category A drugs and are safe to be taken during pregnancy."
C. "Take thyroid hormones if you gain more than the recommended amount of weight during pregnancy."
D. "You don’t need thyroid hormones anymore if you took fertility drugs."
B. "Thyroid hormones are pregnancy category A drugs and should be taken during pregnancy."
Thyroid hormones are classified as pregnancy category A and should be continued by hypothyroid women during pregnancy. Thyroid hormones are not used as treatment for obesity or infertility. Thyroid hormones are used cautiously for clients with heart disease but are safe during pregnancy.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms?
A. hyperpituitarism
B. hypopituitarism
C. panhypopituitarism
D. panhyperpituitarism
A. hyperpituitarism (AKA: Acromegaly).
Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A patient with adrenal insufficiency is experiencing a crisis. Which medication should the nurse prepare to administer?
A) Levothyroxine
B) Prednisone
C) Metformin
D) Insulin
B. Prednisone
A nurse is caring for a client who has hyperparathyroidism. Based on this diagnosis, the nurse should monitor the client for which of the following?
A. Tetany
B. Chvostek's sign
C. Pathologic fractures
D. Dysphagia
C. Pathologic fractures
Hyperparathyroidism results in the release of calcium and phosphate into the blood, which decreases bone density and places the client at risk for pathologic fractures.
A nurse is preparing to administer DDAVP to a patient with central diabetes insipidus. Which of the following assessments should the nurse perform prior to administration?
A) Assess the patient's blood glucose level.
B) Monitor the patient's urine output and specific gravity.
C) Check for signs of hyperkalemia.
D) Evaluate the patient's blood pressure and heart rate.
B) Monitor the patient's urine output and specific gravity.
Rationale: Before administering DDAVP, it's essential to assess the patient's urine output and specific gravity to evaluate the effectiveness of treatment for diabetes insipidus. DDAVP works by promoting water reabsorption in the kidneys, which should lead to decreased urine output and increased specific gravity.
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
a. Diabetic ketoacidosis
b. Thyroid crisis
c. Hypoglycemia
d. Tetany
B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?
A. Sodium level of 136 (reference range: 135 - 145)
B. Patient reports urinating more frequently.
C. Potassium level of 5.0 (reference range: 3.5 - 5)
D. Assessment finding of crackles throughout the lung fields.
D. Assessment finding of crackles throughout the lung fields.
Assessment finding of crackles throughout the lung fields. Remember that when administering a hypertonic solution you have to do this very slowly and watch for volume overload. Hypertonic solutions pull fluid from the cell (which is already water intoxicated) and place it back into the vascular system...therefore, crackles in the lungs are a sign there is too much fluid in the body and the heart can not compensate so the fluid is backing up into the lungs. This would require intervention.
In explaining the condition to a client, a nurse would say that Cushing's syndrome is caused primarily by:
A. Low levels of glucocorticoids
B. Excess secretion of sodium
C. Autoimmunity in the pancreas
D. Elevated levels of cortisol
D. Elevated levels of cortisol
Cushing's syndrome is caused by elevated levels of cortisol. Glucocorticoids tend to cause this
The nurse is caring for a client with hypoparathyroidism. When the nurses places a BP cuff on the upper arm and inflates it between the systolic and diastolic BP for 3 minutes, the nurse observes a spasm of the hand (carpopedal spasm), with the hand flexing inward. What is this response documented as related to the low calcium levels?
A. Positive Chvostek’s sign
B. Positive Trousseau’s sign
C. Negative Chvostek's sign
D. Positive Babinski’s sign
B. Positive Trousseau’s sign
The treatment protocol for a client with hyperthyroidism includes antithyroid medication and propranolol. The purpose of propranolol is to do which of the following?
A. Decrease tachycardia
B. Promote weight loss
C. Decrease the risk of infection
D. Relieve coughing
A. Decrease tachycardia
Propranolol is an adrenergic blocking agent. It is prescribed as adjunctive treatment for several weeks during antithyroid treatment, until the therapeutic effects of the antithyroid drug are obtained. Propranolol decreases tachycardia and palpitations, but it does not decrease the risk of infection or relieve coughing. People with hyperthyroidism tend to have difficulty with keeping weight on, a medication to enhance this effect would not be prescribed as part of the client's treatment.
A nurse is assessing a patient with suspected myxedema. Which of the following symptoms should the nurse expect to find in this patient? (Select all that apply.)
A) Hypothermia
B) Puffy face and swelling of the extremities
C) Increased heart rate
D) Dry, coarse skin
E) Mental confusion and lethargy
F) Hypertension
Correct Answers: A) Hypothermia, B) Puffy face and swelling of the extremities, D) Dry, coarse skin, E) Mental confusion and lethargy
Rationale: Myxedema is characterized by severe hypothyroidism, leading to symptoms such as hypothermia, edema (especially in the face and extremities), dry and coarse skin, and mental changes like confusion and lethargy. An increased heart rate is typically not associated with myxedema; rather, bradycardia is more common in hypothyroidism.
A nurse is monitoring a client who received desmopressin (DDAVP) to treat diabetes insipidus. Which of the following findings indicates effectiveness of the medication?
A. Serum sodium 150 mEq/L (reference range: 135 - 145)
B. Decreased blood pressure
C. Urine specific gravity 1.015
D. Seizures
C. Urine specific gravity 1.015
Diabetes insipidus occurs when the posterior pituitary gland does not secrete enough antidiuretic hormone causing excessive, diluted urine. Desmopressin provides replacement posterior pituitary hormone; therefore, the nurse should identify a urine specific gravity level within the expected reference range indicates effectiveness of the medication.
A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical manifestations should the nurse expect to observe? (Select all that apply.)
A. Obese extremities
B. Buffalo hump
C. Moon face
D. Hyperglycemia
E. Hypotension
B,C,E
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?
A. Sodium bicarbonate
B. Fludrocortisone
C. Calcium gluconate
D. Methylprednisolone
C. Calcium gluconate
Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.
What assessment findings would the nurse expect to see in a client who has overdosed on levothyroxine?
A. nervousness, tachycardia, tremors
B. somnolence, bradycardia, paresthesia
C. hyperglycemia, hypertension, edema
D. central obesity, constipation, sodium loss
A. nervousness, tachycardia, tremors
More pronounced adverse effects of levothyroxine would be seen including tremors, headache, nervousness, palpitations, tachycardia, allergic skin reactions, diarrhea, nausea, and vomiting. Somnolence, bradycardia, and paresthesia would be more likely with insufficient drug intake, which would cause hypothyroidism and other symptoms. Hyperglycemia, edema, central obesity, constipation, or sodium loss would not be associated with excess thyroid hormone.