Show:
Diet
Delegation
Medications
Nursing Interventions
Thyroid
100
The nurse is teaching a patient diagnosed with hyperthyroidism about foods to avoid in her diet. What would the nurse include in her teaching? a.) Broccoli, kale, and cauliflower b.) Salt, caffeine, processed foods c.) Milk, chicken, fish d.) There are no dietary changes/restrictions for this diagnosis
Correct answer: b.) Salt, caffeine, processed foods A patient who has hyperthyroidism should avoid excessive amounts of iodine, which can be found in salt. They should also avoid stimulants such as caffeine and processed foods.
100
The patient received radioactive iodine (Iodine-131) yesterday in an attempt to slow the progression of her hyperthyroid condition. For which healthcare personnel would participating in the patient's direct bedside care be dangerous and therefore should not be delegated to her care? a.) 19-year-old 1st semester nursing student b.) 34-year-old staff nurse who is new to the unit c.) 22-year-old aid who is 6 weeks pregnant d.) 42-year-old RN who has just returned from sick leave
Correct answer: c.) the 22-yr-old aid who is pregnant. Pregnant staff members should avoid exposure to radioactivity because it can damage the fetus, therefore it would be incorrect to delegate the staff member to this patient.
100
To control the side effects of corticosteroid therapy, the nurse instructs the patient who is taking corticosteroids to: a.) Increase calcium intake to 1500 mg/day b.) Perform blood glucose monitoring for hypoglycemia c.) Obtain immunizations due to high risk of infection d.) Avoid abrupt position changes because of orthostatic hypotension
Correct answer: a.) Increase calcium intake to 1500 mg/day Long-term use of corticosteroids can lead to bone loss, osteoporosis, and broken bones. Increasing calcium intake can reduce these side effects.
100
The nurse is planning the care of a client diagnosed with Addison’s disease. Which intervention should be included? 1. Administer steroid medications. 2. Place the client on fluid restriction. 3. Provide frequent stimulation. 4. Consult physical therapy for gait training.
1. Clients diagnosed with Addison’s disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal gland.
100
Which statement by the client would make the nurse suspect the client has hypothyroidism? 1. “I wake up at night feeling hot all over.” 2. “I have a bowel movement once a day.” 3. “I keep putting lotion on my dry skin.” 4. “I have trouble going to sleep at night.”
Correct answer 3: The client with hypothyroidism has dry skin; thin, dry hair; cold intolerance, constipation, dull emotions, and fatigue.
200
The clinic nurse is teaching the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? 1. Tell the client to decrease fluid intake to 1000 mL a day. 2. Encourage the client to eat foods high in fiber. 3. Recommend the client take a daily laxative. 4. Discourage the client from eating fresh fruits and vegetables.
Correct answer 2: The client with hypothyroidism experiences constipation; therefore, the client should have a diet high in fiber. The client should also increase fluid intake to 3000 mL a day. The nurse should discourage daily laxatives or enemas.
200
Which medication teaching should the nurse discuss with the client diagnosed with hypothyroidism who is prescribed levothyroxine (Synthroid)? 1. Explain the need to monitor thyroid levels daily. 2. Inform the client to avoid foods high in iodine. 3. Instruct the client to monitor weight monthly. 4. Tell the client chest pain may occur while taking medication
Correct answer 2: Foods high in iodine will cause the levothyroxine not to be effective. Thyroid level is monitored monthly, not daily. Weights should be daily, not monthly. Synthroid should be administered cautiously in clients with cardiovascular disease.
200
The nurse identifies the client problem “risk for imbalanced body temperature” for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? 1. Discourage the use of an electric blanket. 2. Assess the client’s temperature every two (2) hours. 3. Keep the room temperature cool. 4. Space activities to promote rest.
1. External heat sources (heating pads, electric or warming blankets) should be discouraged because they increase the risk of peripheral vasodilation and vascular collapse.
200
A patient has just had a total thyroidectomy. The first night she experienced signs and symptoms of postoperative tetany. The nurse should implement the physician's order and immediately administer: a.) sodium iodide PO b.) potassium chloride IV c.) magnesium sulfate IM d.) calcium gluconate IV
Correct answer: d.) calcium gluconate IV. Tetany is a sign of hypocalcemia, so IV calcium gluconate would be the correct intervention to help with the patient's symptoms.
300
A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? 1. "I can eat foods that contain potassium." 2. "I will need to limit the amount of protein in my diet." 3. "I am fortunate that I can eat all the salty foods I enjoy." 4. "I am fortunate that I do not need to follow any special diet."
What is Correct Answer 1: A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.
300
The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid), a hormone replacement. Which data indicate the medication is effective? 1. The client has lost 4 lbs. in 1 week. 2. The client's radial pulse is 88. 3. The client complains of being cold. 4. The client's temperature is 97.0ºF.
Correct answer 2: A radial pulse between 60 and 100 indicates the medication is effective. Weight loss indicates taking too much medication. Being cold and having a subnormal temperature indicate not enough medication.
300
When assessing a postoperative thyroidectomy patient, the nurse checks for damage to the laryngeal nerve. Which is most likely to suggest that damage may have occurred and intervention is needed? a.) The client complains of a slight sore throat b.) The patient's voice tone has changed slightly c.) The patient is unable to swallow fluids d.) The client is becoming increasingly hoarse
Correct answer: d.) The client is becoming increasingly hoarse. Damage to the laryngeal nerve is a complication of surgery and can become serious and result in breathing problems if both the left and right nerves are damaged.
300
Chvostek's sign, Trousseau's sign, carpopedal spasms, and laryngeal spasms are postoperative complications of total thyroidectomy and indicate: a.) low levels of serum calcium b.) high levels of serum calcium c.) low levels of serum potassium d.) high levels of serum potassium
Correct answer: a.) low levels of serum calcium Signs and symptoms of hypocalcemia include Chvostek's sign, Trousseau's sign, carpopedal spasms, and laryngeal spasms; and can occur with the total removal of the thyroid.
400
A patient with secondary hyperparathyroidism questions the nurse regarding the need for adequate vitamin D intake. The nurse understands that Vitamin D is necessary for the parathyroid hormone to exert its effects because: A. Vitamin D decreases calcium absorption. B. Vitamin D activation occurs in the liver. C. Vitamin D is used to synthesize parathyroid hormone. D. Vitamin D increases calcium absorption.
What is: D. Vitamin D increases calcium absorption. Secondary hyperparathyroidism results from a homeostatic mechanism that seeks to compensate for low levels of serum calcium.
400
A pt ask a nurse why she is taking propranolol (Inderal) along with her therapy for hyperthyroidism. Which of the following replies by the nurse is appropriate? a) "propranolol helps increase blood flow to your thyroid gland." b) "propranolol is used to prevent excess glucose in your blood." c) "propranolol will decrease your tremors and fast heart beat." d) "propranolol promotes conversion of T4 to T3 in your body."
What is c) propranolol is a beta-adrenergic antagonist that decreases heart rate and controls tremors.
400
A nurse is caring for a postoperative parathyroidectomy client. Which of the following would require the nurse's immediate attention? 1. Incisional Pain 2. Laryngeal stridor 3. Difficulty Voiding 4. Abdominal cramps
Correct Answer 2: During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which cause swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration that is caused by the compression of the trachea and that leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.
400
What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves' disease? 1. Provide a high-fiber diet. 2. Provide a restful environment. 3. Provide three small meals per day. 4. Provide the client with extra blankets.
Correct Answer 2: Because of the hypermetabolic state, the client with Graves' disease needs to be provided with an environment that is restful both physically and mentally. Six full meals a day that are well balanced and high in calories are required because of the accelerated metabolic rate. Foods that increase peristalsis (e.g., high-fiber foods) need to be avoided. These clients suffer from heat intolerance and require a cool environment.
500
The nurse is educating a pt with hyperparathyroidism about diet modifications. Which of the following should the nurse emphasize? a) force fluids b) increase calcium intake c) restrict fluids d) restrict potassium intake
What is a) force fluids; pt's with hyperparathyroidism have increased serum calcium levels and are at risk for the development of renal calculi. Increasing fluid intake will help prevent renal calculi formation.
500
The charge nurse of an intensive care unit is making assignments for the night shift. Which client should be assigned to the most experienced intensive care nurse? 1. The client diagnosed with respiratory failure who is on a ventilator and requires frequent sedation. 2. The client diagnosed with lung cancer and iatrogenic Cushing’s disease with ABGs of pH 7.35, PaO2 88, PaCO2 44, and HCO3 22. 3. The client diagnosed with Addison’s disease who is lethargic and has a BP of 80/45, P 124, and R 28. 4. The client diagnosed with hyperthyroidism who has undergone a thyroidectomy two (2) days ago and has a negative Trousseau’s sign.
3. This client has a low blood pressure and tachycardia. This client may be experiencing an addisonian crisis, a potentially life-threatening condition. The most experienced nurse should care for this client.
500
A patient with a history of Graves' disease is hypertensive, hyperpyrexic, and agitated. ECG indicates cardiac arrhythmia. Based on the history and client's complaints, which of the following medications would the nurse expect to administer immediately? SELECT ALL THAT APPLY A. Thionamide B. Aspirin C. Ethanol injection D. Propanolol E. Glucocorticoids F. Synthetic thyroxine
What is: A. Thionamide D. Propanolol E. Glucocorticoid Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis, and treated in the same way as uncomplicated hyperthyroidism, except that the drugs are given in higher doses and more frequently.
500
A nurse is caring for a 69-year-old male with hyperthyroidism. To provide additional comfort for the pt, the nurse should do which of the following interventions? a) administer a stool softener to alleviate constipation and abdominal distension. b) apply warm packs to the pt's forehead. c) offer the pt coffee or tea. d) provide a cool environment.
What is d) provide a cool environment: a pt with hyperthyroidism suffers from heat intolerance, so the nurse should maintain a cool environment to promote comfort.
500
A patient is seen in the emergency department after abruptly discontinuing her thyroid medication. She is hypotensive, hypoglycemic, and is unresponsive. This clinical picture is most consistent with: A. Thyroid cancer B. Thyroid storm C. Myxedema coma D. Hypertensive crisis
What is: C. Myxedema coma, occurs from persistently low thyroid production. It occurs after acute illnesses, rapid discontinuation of thyroid medication, or hypothermia.