Chapter 49

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A patient with exophthalmos is distressed about her appearance and asks when it will go away. What is the best response by the nurse?

It usually subsides after medication for hyperthyroidism is started.

A nurse is explaining Graves disease to a newly di- agnosed patient. Which statement by the nurse best clarifies the pathophysiologic changes of Graves disease?

"Your thyroid gland is overactive, but there are ways to treat it through medicine or surgery."

What is the most appropriate nursing concern for the patient recently diagnosed with hyperthyroidism?

Disturbed sleep pattern

A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. What should the nurse's instructions relative to hormone replace- ment include?

"Know the signs and symptoms of hyperthyroidism"

On returning from surgery after undergoing a thy- roidectomy, a patient is alarmed about the large tra- cheostomy tray on the bedside table. What is the nurse's most reassuring response when the patient asks why it is there?

"We have it there as a precaution- ary measure in the unlikely event that you have difficulty breathing."

What is the appropriate action of the nurse when assessing for hemorrhage in a post-thyroidectomy patient?

Examine behind patient's neck and upper back to as- sess for hemorrhage.

How do foods such as soybeans, turnips, and rutaba- gas affect people with thyroid disorders?

Suppress thyroid hormone.

A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier notes that the patient's hand goes into a carpopedal spasm. What should the nurse recognize this movement as an indication of?

Hypocalcemia, called the Trousseau sign

What action should a nurse implement to address dry skin in the patient with hypothyroidism?

Apply lotions and creams to help maintain moisture.

What action should a nurse implement to initiate the Chvostek sign?

Tap the face over the facial nerve and watch for a spasm of the facial muscle.

What symptoms should a nurse anticipate in the history of a patient with hyperparathyroidism?

Poor muscle tone, bone pain, urinary calculi, and fractures

What is the priority nursing concern for a patient with hyperparathyroidism?

Potential urinary obstruction

What is the nurse aware is happening when the patient with hypoparathyroidism complains of fatigue and a lack of energy?

Hypocalcemia has caused decreased cardiac output.

Why are antithyroid medications provided presurgi- cally to a patient with hyperthyroidism? (Select all that apply.)

Decrease the level of hormone in the blood before surgery, Help reduce the risk of hemorrhage during surgery, Decrease the threat of a thyroid storm, Reduce exophthalmia

To meet the nutritional needs of a patient with Graves disease, the nurse recommends a diet of 4,000 to ______ calories. (Use numeric characters only, no punctuation.)

5000

Congenital hypothyroidism, if left untreated, will result in ______.

cretinism

A physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain, muscle aches and pains, and constipation. Which laboratory test results will help confirm the diagnosis of hy- pothyroidism?

Both tests show decreases.

Which instruction should a nurse provide when a pa- tient starts taking a saturated solution of potassium iodide (SSKI)?

Sip medication through a straw to prevent tooth staining.

A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. What is the best suggestion by the nurse?

Adhering to a bedtime ritual

Which significant need should be included in instructions to a patient scheduled for a thyroid scan (123I)?

Wash their hands with soap and water after every voiding for the next 24 hours

A patient asks about his laboratory test, which showed a high level of thyroid-stimulating hormone (TSH) and a low level of T4. What is the most accurate explanation?

"The TSH is send- ing a message to your thyroid gland to increase production, but your thy- roid isn't producing enough hormone."

A nurse assessing a patient 1 day after a subtotal thyroidectomy notes that the patient's color is poor the pulse and respirations are rapid, and the patient feels warm to the touch. The patient says that she feels frightened. What is the best initial implementa- tion by the nurse?

Call the charge nurse; these are signs of a thyroid storm.

A patient has been given an antithyroid drug called propylthiouracil. What appropriate nursing implementations should be included

Teaching her to watch for and report any signs and symptoms of hypothyroidism or infections

What is the most appropriate nursing diagnosis for the patient recently diagnosed with hyperthyroidism?

Disturbed sleep pattern, related to metabolic disturbance

What patient recommendation should a nurse in- clude when preparing to present presurgical teaching of a patient scheduled for a subtotal thyroidectomy?

Demonstrate how to deep breathe and support her head during position changes.

What is the appropriate action of the nurse when assessing for hemorrhage in a postthyroidectomy patient?

Examine behind patient's neck and upper back to assess for hemorrhage.

An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she has taken for 15 years, has been reduced. What is nurse's best rationale when explaining what the decreased dose is related to?

Age-related reduction in metabolic rate

What action should a nurse implement to address the nursing diagnosis, "Risk for impaired skin integrity, related to dry skin" in the patient with hypothyroidism?

Apply lotions and creams to help maintain moisture.

A patient being treated for hyperparathyroidism is to receive calcitonin (Calcimar). Which patient assessment should occur before this medication is administered?

Test for sensitivity

What is an appropriate nursing diagnosis for a patient with hyperparathyroidism

Impaired urinary elimination, related to urinary calculi

Why should a nurse recommend the use of salt that is iodized when providing dietary education to patients?

It prevents the development of goiter in adults and cretinism in infants.

What should a nurse caring for a patient with hyper- thyroidism include when developing a plan of care? (Select all that apply.)

Provision of cool environment, Eye care, Nutritional support, Prevention of diarrhea

A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a thionamide drug, should report. What should this list include? Select all that apply

Becoming pregnant, Jaundice, Blood in the stool, rash

Why is hypothyroidism frequently overlooked in older adults? (Select all that apply.)

signs and symptoms are subtle, Signs and symptoms are discounted as age-related changes., Weight changes in the older adult are not pronounced., Decrease in mental function is attributed to dementia.

A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

"Do you have to wear larger shoes now?"

A patient is scheduled for transsphenoidal hypophy- sectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to

avoid brushing teeth for at least 10 days after the surgery.

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included

Measure urine volume every hour.

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include

decreased facial hair.

Which information will the nurse include when teaching a 50-yr-old male patient about somatropin (Genotropin)

Inject the medication subcutaneously every day.

The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's

urinary output is increased.

A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. Which is the best suggestion by the nurse?

Adhering to a bedtime ritual

A patient with exophthalmos is distressed about her appearance and asks when it will go away. Which is the best response by the nurse?

It usually subsides after medication for hyperthyroidism is started.

A nurse assessing a patient 1 day after a subtotal thyroidectomy notes that the patient's color is poor, the pulse and respirations are rapid, and the patient feels warm to the touch. The patient says that she feels frightened. Which action is the best initial im- plementation by the nurse?

Call the charge nurse; these are signs of a thyroid storm.

Which is the most appropriate nursing concern for the patient recently diagnosed with hyperthyroidism

Disturbed sleep pattern

A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. Which information should the nurse's instructions relative to hormone replacement include?

"Know the signs and symptoms of hy- perthyroidism."

Which patient recommendation should a nurse include when preparing to present presurgical teaching of a patient scheduled for a subtotal thyroidectomy?

Demonstrate how to deep breathe and support her head during position changes.

On returning from surgery after undergoing a thyroidectomy, a patient is alarmed about the large tracheostomy tray on the bedside table. Which reply is the nurse's most reassuring response when the patient asks why it is there?

"We have it there as a precautionary measure in the unlikely event that you have difficulty breathing."

Which action is the most appropriate for the nurse to implement when assessing for hemorrhage in a post-thyroidectomy patient?

Examine behind patient's neck and upper back to assess for hemorrhage.

Which statement correctly reflects how foods, such as soybeans, turnips, and rutabagas, affect people with thyroid disorders?

Suppress thyroid hormone.

A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier notes that the patient's hand goes into a carpopedal spasm. Which disorder should the nurse recognize this movement as an indication of?

Hypocalcemia, called the Trousseau sign

Which action should a nurse implement to address dry skin in the patient with hypothyroidism?

Apply lotions and creams to help maintain moisture

Which action should a nurse implement to initiate the Chvostek sign

Tap the face over the facial nerve and watch for a spasm of the facial muscle.

Which symptoms should a nurse anticipate in the history of a patient with hyperparathyroidism?

Poor muscle tone, bone pain, urinary calculi, and fractures

Which problem is the priority nursing concern for a patient with hyperparathyroidism

Potential urinary obstruction

Which problem is the nurse aware is happening when the patient with hypoparathyroidism com- plains of fatigue and a lack of energy?

Hypocalcemia has caused decreased cardiac output.

Which intervention is necessary to assist a patient with hypothyroidism to understand how he can live a full and normal life?

Encourage treatment with thyroid replacement therapy.

Which statement explains why antithyroid medications are provided presurgically to a patient with hyperthyroidism? (Select all that apply.)

To decrease the level of hormone in the blood before surgery, To help reduce the risk of hemorrhage during surgery, To decrease the threat of a thyroid storm, To reduce exophthalmia

Congenital hypothyroidism, if left untreated, will result in.

cretinism

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