Ch 54: Acute Thyrotoxicosis Flashcards
A nurse is caring for a patient with known hyperthyroidism who presents to the ED with a temperature of 105.8°F (41°C), heart rate of 152 bpm, agitation, and vomiting. Which priority action should the nurse take?
A. Administer acetaminophen and monitor the patient
B. Prepare to administer IV beta-blockers and antithyroid medications
C. Place the patient on NPO status and observe for improvement
D. Reassure the patient and recheck vital signs in 15 minutes
B. Prepare to administer IV beta-blockers and antithyroid medications
Rationale: The patient is showing signs of acute thyrotoxicosis (thyroid storm), a life-threatening emergency. The priority is to decrease circulating thyroid hormone effects and control symptoms such as tachycardia and hyperthermia. Beta-blockers and antithyroid meds are first-line interventions.
A 34-year-old female with a history of Graves’ disease underwent a thyroidectomy 24 hours ago. She now presents with a HR of 160 bpm, temp of 104.6°F, severe abdominal pain, and confusion. Which complication is she most likely experiencing?
A. Myxedema coma
B. Thyroid carcinoma recurrence
C. Post-operative infection
D. Acute thyrotoxicosis
D. Acute thyrotoxicosis
Rationale: Surgical manipulation of the thyroid gland in a hyperthyroid patient can trigger thyroid storm. Her symptoms—hyperthermia, tachycardia, abdominal pain, and confusion—are classic signs.
Which of the following is the most likely precipitating factor for acute thyrotoxicosis in a patient with untreated hyperthyroidism?
A. Daily multivitamin intake
B. Physical exertion
C. Mild seasonal allergy
D. Surgical trauma
D. Surgical trauma
Rationale: Acute thyrotoxicosis is often triggered by stressors like infection, trauma, or surgery—especially thyroid surgery—in patients with hyperthyroidism.
Which of the following signs and symptoms would the nurse expect to find in a patient with acute thyrotoxicosis? (SATA)
A. Hyperthermia
B. Bradycardia
C. Diarrhea
D. Seizures
E. Hypotension
F. Abdominal pain
A. Hyperthermia
C. Diarrhea
D. Seizures
F. Abdominal pain
Rationale: Thyroid storm presents with hypermetabolic symptoms such as hyperthermia, diarrhea, seizures, and abdominal pain. Bradycardia and hypotension are not characteristic; instead, you’d typically see tachycardia and possible hypertension or shock.
A patient in the ICU with suspected thyroid storm is unresponsive and has a temp of 106.1°F. Which provider order should the nurse question?
A. Administer IV propranolol
B. Administer high-dose acetaminophen
C. Insert Foley catheter
D. Administer IV levothyroxine
D. Administer IV levothyroxine
Rationale: Levothyroxine is synthetic thyroid hormone and would worsen the condition. The goal is to reduce circulating thyroid hormone levels.
A patient with thyroid storm is admitted. What is the primary goal of treatment during the initial phase?
A. Increase thyroid hormone levels
B. Replace calcium to prevent tetany
C. Block the effects of circulating thyroid hormone
D. Encourage early ambulation to prevent DVT
C. Block the effects of circulating thyroid hormone
Rationale: Management focuses on reducing the effects of excess hormones through beta-blockers, antithyroid drugs, and supportive care.
A nurse notes new-onset confusion, restlessness, and a rising temperature in a post-thyroidectomy patient. Which action is most appropriate?
A. Notify the provider immediately
B. Reposition the patient and reassess in 30 minutes
C. Document the findings as expected post-op
D. Administer PRN pain medication
A. Notify the provider immediately
Rationale: These symptoms may indicate thyroid storm. Prompt action is required to prevent deterioration.
A 45-year-old male presents to the ED with agitation, vomiting, and a fever of 105.9°F. Labs confirm hyperthyroidism. The nurse suspects thyroid storm. What additional finding would support this diagnosis?
A. Hypotension
B. Bradycardia
C. Seizures
D. Constipation
C. Seizures
Rationale: Seizures are a severe neurological manifestation of acute thyrotoxicosis, supporting the diagnosis.
Which of the following medications is commonly used to block peripheral effects of thyroid hormone in thyroid storm?
A. Methimazole
B. Levothyroxine
C. Propranolol
D. Iodine solution
C. Propranolol
Rationale: Propranolol, a beta-blocker, is used to block adrenergic effects like tachycardia and tremors during thyroid storm.
Which of the following interventions are appropriate for a patient in thyroid storm? (SATA)
A. Monitor for cardiac dysrhythmias
B. Maintain a warm environment
C. Administer antipyretics
D. Initiate seizure precautions
E. Encourage oral fluids immediately
A. Monitor for cardiac dysrhythmias
C. Administer antipyretics
D. Initiate seizure precautions
Rationale: The patient is at risk for cardiac instability and seizures. Antipyretics help manage hyperthermia. A cool environment is needed, and oral fluids are avoided if the patient is vomiting or has altered mental status.
A nurse is caring for a patient experiencing thyroid storm. The nurse understands that the underlying pathophysiology is best described as:
A. Acute adrenal insufficiency triggered by infection
B. A sudden decrease in circulating T3 and T4
C. An overwhelming release of thyroid hormones into circulation
D. Chronic hypothyroid state with metabolic suppression
C. An overwhelming release of thyroid hormones into circulation
Rationale: Thyroid storm results from a surge in T3 and T4 hormones, leading to life-threatening systemic effects.
A patient receiving treatment for thyroid storm suddenly becomes hypotensive and unresponsive. What is the nurse’s priority action?
A. Check blood glucose
B. Begin CPR
C. Notify the Rapid Response Team
D. Administer IV fluids
C. Notify the Rapid Response Team
Rationale: A sudden decline in LOC and BP in a thyroid storm patient indicates rapid decompensation. Activating the RRT ensures immediate collaborative emergency intervention.
Which lab value would a nurse expect in a patient experiencing acute thyrotoxicosis?
A. Suppressed TSH with elevated T3 and T4
B. Decreased serum T3 and T4
C. Elevated TSH
D. Elevated calcium levels
A. Suppressed TSH with elevated T3 and T4
Rationale: TSH is suppressed in hyperthyroidism, while T3 and T4 are elevated. This hormonal pattern is intensified in thyroid storm.
A nurse in the ICU suspects thyroid storm in a patient with no prior diagnosis of hyperthyroidism. Which diagnostic clue would most strongly support this suspicion?
A. New-onset bradycardia
B. Recent major infection
C. Decreased bowel sounds
D. Hypothermia
B. Recent major infection
Rationale: Thyroid storm is often precipitated by a major stressor such as infection, trauma, or surgery in patients with unrecognized hyperthyroidism.
What is the nurse’s role in preventing thyroid storm post-thyroidectomy?
A. Ensure the patient avoids iodine-rich foods
B. Encourage early ambulation
C. Increase oral intake to prevent dehydration
D. Monitor closely for signs of hormone release and report immediately
D. Monitor closely for signs of hormone release and report immediately
Rationale: Post-op manipulation of the gland can lead to hormone surges. Early detection and intervention are key to preventing thyroid storm.
