Chapter 63: Care of Patients with Problems of the Thyroid and Parathyroid Glands

Question 1

1. A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy?
   a. Blurred and double vision
   b. Increased thirst and urination
   c. Profuse nausea and diarrhea
   d. Decreased attention and insomnia

Answer 1

ANS: B
Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.

Question 2

2. A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
   a. Reassure the client that the voice change is temporary.
   b. Document the finding and assess the client hourly.
   c. Place the client in high-Fowlers position and apply oxygen.
   d. Contact the provider and prepare for intubation.

Answer 2

ANS: D
Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.

Question 3

3. A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, I feel numbness and tingling around my mouth. What action should the nurse take?
   a. Offer mouth care.
   b. Loosen the dressing.
   c. Assess for Chvosteks sign.
   d. Ask the client orientation questions.

Answer 3

ANS: C
Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvosteks sign and Trousseaus sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

Question 4

4. A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism?
   a. My sister has thyroid problems.
   b. I seem to feel the heat more than other people.
   c. Food just doesnt taste good without a lot of salt.
   d. I am always tired, even with 12 hours of sleep.

Answer 4

ANS: D
Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.

Question 5

5. A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client?
   a. Atropine sulfate
   b. Levothyroxine sodium (Synthroid)
   c. Propranolol (Inderal)
   d. Epinephrine (Adrenalin)

Answer 5

ANS: B
The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

Question 6

6. A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client?
   a. Heat intolerance
   b. Body image problems
   c. Depression and withdrawal
   d. Obesity and water retention

Answer 6

ANS: C
Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The clients family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the clients environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.

Question 7

7. A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective?
   a. Thirst is recognized and fluid intake is appropriate.
   b. Weight has been the same for 3 weeks.
   c. Total white blood cell count is 6000 cells/mm3.
   d. Heart rate is 70 beats/min and regular.

Answer 7

ANS: D
Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a clients heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

Question 8

8. A nurse cares for a client who has hypothyroidism as a result of Hashimotos thyroiditis. The client asks, How long will I need to take this thyroid medication? How should the nurse respond?
   a. You will need to take the thyroid medication until the goiter is completely gone.
   b. Thyroiditis is cured with antibiotics. Then you wont need thyroid medication.
   c. Youll need thyroid pills for life because your thyroid wont start working again.
   d. When blood tests indicate normal thyroid function, you can stop the medication.

Answer 8

ANS: C
Hashimotos thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication.

Question 9

9. A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism?
   a. A 29-year-old female with pregnancy-induced hypertension
   b. A 41-year-old male receiving dialysis for end-stage kidney disease
   c. A 66-year-old female with moderate heart failure
   d. A 72-year-old male who is prescribed home oxygen therapy

Answer 9

ANS: B
Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

Question 10

10. A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this clients plan of care?
    a. Ask the client to ambulate in the hallway twice a day.
    b. Use a lift sheet to assist the client with position changes.
    c. Provide the client with a soft-bristled toothbrush for oral care.
    d. Instruct the unlicensed assistive personnel to strain the clients urine for stones.

Answer 10

ANS: B
Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client.

Question 11

11. A nurse cares for a client who is recovering from a parathyroidectomy. When taking the clients blood pressure, the nurse notes that the clients hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition?
    a. Serum potassium: 2.9 mEq/L
    b. Serum magnesium: 1.7 mEq/L
    c. Serum sodium: 122 mEq/L
    d. Serum calcium: 6.9 mg/dL

Answer 11

ANS: D
Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseaus sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.

Question 12

12. A nurse cares for a client newly diagnosed with Graves disease. The clients mother asks, I have diabetes mellitus. Am I responsible for my daughters disease? How should the nurse respond?
    a. The fact that you have diabetes did not cause your daughter to have Graves disease. No connection is known between Graves disease and diabetes.
    b. An association has been noted between Graves disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves disease.
    c. Graves disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus.
    d. Unfortunately, Graves disease is associated with diabetes, and your diabetes could have led to your daughter having Graves disease.

Answer 12

ANS: B
An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mothers diabetes did not cause her daughters Graves disease. The other statements are inaccurate.

Question 13

13. While assessing a client with Graves disease, the nurse notes that the clients temperature has risen 1 F. Which action should the nurse take first?
    a. Turn the lights down and shut the clients door.
    b. Call for an immediate electrocardiogram (ECG).
    c. Calculate the clients apical-radial pulse deficit.
    d. Administer a dose of acetaminophen (Tylenol).

Answer 13

ANS: A
A temperature increase of 1 F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.

Question 14

14. After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional instruction?
    a. I may need calcium replacement after surgery.
    b. After surgery, I wont need to take thyroid medication.
    c. Ill need to take thyroid hormones for the rest of my life.
    d. I can receive pain medication if I feel that I need it.

Answer 14

ANS: B
After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively

Question 15

15. A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this clients plan of care?
    a. Monitor the clients intravenous site every shift.
    b. Administer acetaminophen (Tylenol) for fever.
    c. Ensure that working suction equipment is in the room.
    d. Assess the clients vital signs every 4 hours.

Answer 15

ANS: C
A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the clients room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.

Question 16

1. A nurse evaluates the following laboratory results for a client who has hypoparathyroidism:
Calcium 7.2 mg/dL
Sodium 144 mEq/L
Magnesium 1.2 mEq/L
Potassium 5.7 mEq/L
Based on these results, which medications should the nurse anticipate administering? (Select all that apply.)
a. Oral potassium chloride
b. Intravenous calcium chloride
c. 3% normal saline IV solution
d. 50% magnesium sulfate
e. Oral calcitriol (Rocaltrol)

Answer 16

ANS: B, D
The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The clients sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

Question 17

2. A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.)
   a. Administer levothyroxine (Synthroid).
   b. Administer propranolol (Inderal).
   c. Monitor the apical pulse.
   d. Assess for Trousseaus sign.
   e. Initiate telemetry monitoring.

Answer 17

ANS: C, E
The clients laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the clients heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseaus sign is a test for hypocalcemia.

Question 18

3. A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this clients teaching? (Select all that apply.)
   a. Increased carbohydrates
   b. Decreased fats
   c. Increased calorie intake
   d. Supplemental vitamins
   e. Increased proteins

Answer 18

ANS: A, C, E
The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

Question 19

4. A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the clients level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.)
   a. Infuse intravenous fluids.
   b. Cover the client with warm blankets.
   c. Monitor blood pressure every 4 hours.
   d. Maintain a patent airway.
   e. Administer oral glucose as prescribed.

Answer 19

ANS: A, B, D
A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

Question 20

5. A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this clients education? (Select all that apply.)
   a. Do not share utensils, plates, and cups with anyone else.
   b. You can play with your grandchildren for 1 hour each day.
   c. Eat foods high in vitamins such as apples, pears, and oranges.
   d. Wash your clothing separate from others in the household.
   e. Take a laxative 2 days after therapy to excrete the radiation.

Answer 20

ANS: A, D, E
A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other peoples clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.