Lewis Chapter 51: Endocrine Problems

Question 1

Which statement would the nurse make when teaching a patient diagnosed with goitre?

A. “Your thyroid is abnormally small.”

B. “A goitre is only caused by a lack of iodine.”

C. “We need to measure your thyroid hormones levels.”

D. “Having a goitre means that you have thyroid cancer.”

Answer 1

C. “We need to measure your thyroid hormones levels.”

In a patient with a goitre, thyroid hormone levels should be drawn to evaluate if thyroid function is normal, hypoactive, or hyperactive.

Question 2

Match the type of thyroid cancer to its description.

Most common form, slow growing
Papillary

Grows first into cervical lymph nodes
Follicular

More likely to occur in families
Medullary

Most aggressive form
Anaplastic

Question 3

Which characteristic describes Hashimoto’s thyroiditis?

A. Occurs in women who have recently given birth

B. A chronic autoimmune disorder

C. Most common in males

D. Caused by a bacterial or fungal infection

Answer 3

B. A chronic autoimmune disorder

Hashimoto’s thyroiditis is a chronic autoimmune disorder in which thyroid tissue is replaced by lymphocytes and fibrous tissue.

Question 4

Which characteristic is associated with Graves’ disease?

A. Causes a decrease in thyroid-stimulating hormone (TSH) secretion

B. Occurs more often in men than women

C. The most common cause of hyperthyroidism

D. A type of thyroid cancer

Answer 4

C. The most common cause of hyperthyroidism

Graves’ disease accounts for approximately 90% of the cases of hyperthyroidism in Canada.

Question 5

Which assessment finding supports the diagnosis of a thyrotoxic crisis (thyroid storm)? Select all that apply. One, some, or all responses may be correct.

A. Bradycardia

B. Elevated body temperature

C. Altered mental status

D. Hypothermia

E. Tachycardia

F. Nausea and vomiting

Answer 5

B, C, E, F.
An elevated body temperature supports the diagnosis of a thyroid storm.
An altered mental status, manifested by restlessness, agitation, delirium, and coma, can occur during a thyrotoxic crisis.
The presence of tachycardia supports the diagnosis of a thyroid storm.
Nausea and vomiting can occur during a thyrotoxic crisis.

Question 6

Which information would the nurse include when teaching about radioactive iodine (RAI)?

A. Often induces hypothyroidism.

B. Has no side effects.

C. Can be used for pregnant patients.

D. Causes an immediate decrease in thyroid hormones.

Answer 6

A. Often induces hypothyroidism.

There is a high incidence of hypothyroidism after radioactive iodine (RAI) treatment.

Question 7

Which assessment finding supports the diagnosis of a myxedema coma?

A. Severe hypertension

B. Decreased body temperature

C. Hyperventilation breathing patterns

D. Profuse sweating

Answer 7

B. Decreased body temperature

Hypothermia is expected in a patient experiencing a myxedema coma.

Question 8

Which laboratory value is suggestive of hypothyroidism?

A. Elevated thyroid-stimulating hormone (TSH) levels

B. Lack of thyroid peroxidase antibodies

C. Decreased triglyceride levels

D. Elevated red blood cell count

Answer 8

A. Elevated thyroid-stimulating hormone (TSH) levels

Elevated thyroid-stimulating hormone (TSH) levels suggest hypothyroidism with the defect present in the thyroid gland.

Question 9

Which instruction would the nurse provide to a patient diagnosed with hypothyroidism? Select all that apply. One, some, or all responses may be correct.

A. Avoid missing doses of thyroid replacement hormone.

B. Report shortness of breath to the health care provider.

C. Expect heart palpitations as a side effect of the medication.

D. Increased dietary fibre and exercise to avoid constipation.

E. Increase dosage of sedative medications, if taken.

F. Stay in environments that are warm and comfortable.

Answer 9

A, B, D, F.
It is essential to avoid missing doses of thyroid replacement hormone to maintain a euthyroid state.
Orthopnea and dyspnea should be provided to the health care provider as they can be signs of overdose.
Constipation is a significant risk in hypothyroidism so measures should be taken to maintain regular bowel elimination.
Patients with hypothyroidism should be told to stay in warm and comfortable environments.

Question 10

Which laboratory value would the nurse expect to see in a patient with hyperparathyroidism?

A. Elevated urine calcium levels

B. Decreased serum calcium levels

C. Elevated serum phosphorus levels

D. Decreased serum chloride levels

Answer 10

A. Elevated urine calcium levels

Elevations in urine calcium are expected in a patient with hyperparathyroidism.

Question 11

When caring for a postoperative patient who received a parathyroidectomy, which medication should be available in case of tetany?

A. Thyroxine

B. Norepinephrine

C. Calcium gluconate

D. Amiodarone

Answer 11

C. Calcium gluconate

Intravenous calcium gluconate should be available in case of tetany, which occurs due to a sudden decrease in calcium levels.

Question 12

Which instruction would the nurse provide to a patient with hypoparathyroidism?

A. Take high doses of Vitamin D supplements.

B. Consume a meal plan that is high in calcium.

C. Eat foods rich in oxalic acid and phytic acid.

D. Devise a meal plan that is high in phosphorus.

Answer 12

B. Consume a meal plan that is high in calcium.

Patients with hypoparathyroidism should consume a diet that is rich in calcium to maintain adequate serum levels.

Question 13

Which statement describes the relationship between aging and thyroid function? Select all that apply. One, some, or all responses may be correct.

A. Older persons are more likely to develop toxic nodular goitres than younger persons.

B. Signs of hyperthyroidism in older persons can be mistaken as dementia.

C. Older persons with hyperthyroidism are more likely to develop a goitre than younger persons.

D. Older persons with hypothyroidism do not develop the typical mental and emotional signs.

E. Older persons with hypothyroidism will require a higher dose of levothyroxine due to slower metabolism.

F. Older persons are more likely to develop cardiac complications of hormone replacement treatment.

Answer 13

A, B, F.
Frequency of toxic nodular goitres is highest in people older than 40 years.
In older persons, the signs of hyperthyroidism, such as confusion and agitation, can be viewed as signs of dementia and may delay a proper diagnosis.
Thyroid hormone replacement can increase myocardial oxygen demand which can induce dysrhythmias or angina.

Question 14

Which term describes the protrusion of the eyes that can occur with thyroid dysfunction?

A. Exophthalmos

B. Goitre

C. Bruits

D. Tetany

Answer 14

A. Exophthalmos
Exophthalmos describes the protrusion of the eyes that can occur in thyroid dysfunction.

Question 15

Which intervention would the nurse incorporate into the plan of care for a patient being treated for acute thyrotoxicosis?

A. Administering intravenous levothyroxine

B. Maintaining strict bedrest

C. Providing a quiet environment

D. Keeping the room temperature warm

Answer 15

C. Providing a quiet environment
Providing a quiet environment is essential for patients experiencing a thyrotoxic crisis to allow for rest and recovery.

Question 16

Which characteristic describes thyroid nodules?

A. Always malignant

B. Secrete parathyroid hormone

C. Always benign

D. Can cause tracheal compression

Answer 16

D. Can cause tracheal compression
Thyroid nodules can cause tracheal compression if they become too large.

Question 17

Which teaching point about the intravenous administration of calcium would the nurse include when providing education?

A. Used for mild tetany.

B. Can cause tissue necrosis.

C. Infused rapidly.

D. Can induce hypertension.

Answer 17

B. Can cause tissue necrosis.
Careful administration of calcium is needed as extravasation can cause cellulitis, necrosis, and tissue sloughing.

Question 18

In which way does iodine consumption contribute to thyroid function? Select all that apply. One, some, or all responses may be correct.

A. Excess iodine consumption does not impact thyroid function.

B. Lack of iodine consumption can contribute to hypothyroidism.

C. A goitre can be caused by a lack of iodine consumption.

D. Large doses of iodine increase the release of T3 and T4.

E. Iodine administration decreases thyroid gland vascularity.

F. Lack of iodine consumption induces most thyroid disease among Canadians.

Answer 18

B, C, E.
Lack of iodine consumption can contribute to the development of hypothyroidism, a goitre, and Graves’ disease.
Lack of iodine consumption can contribute to the development of a goitre, Graves’ disease, and hypothyroidism.
Iodine administration can decrease the vascularity of the thyroid gland.

Question 19

Which information would the nurse provide to a patient diagnosed with Graves’ disease?

A. Characterized by hormone-secreting tumours.

B. Will not develop a goitre or any thyroid enlargement.

C. Can be cured with compliance to treatment.

D. Causes hyperthyroidism but can also lead to hypothyroidism.

Answer 19

D. Causes hyperthyroidism but can also lead to hypothyroidism.
While Graves’ disease is a common cause of hyperthyroidism, it can progress to tissue destruction which can cause hypothyroidism.

Question 20

Which consideration would the nurse take when caring for a patient in a myxedema coma?

A. A myxedema coma is rarely fatal.

B. An infection can precipitate a myxedema coma.

C. A patient in a myxedema coma will be hypertensive.

D. A myxedema coma is treated with oral levothyroxine.

Answer 20

B. An infection can precipitate a myxedema coma.
A myxedema coma can be precipitated by infection, medications, cold exposure, and trauma.

Question 21

Which assessment finding supports the diagnosis of hypothyroidism?

A. Weight loss

B. Constipation

C. Agitation

D. A bounding pulse

Answer 21

B. Constipation
Constipation is a common symptom associated with hypothyroidism.

Question 22

Which statement would the nurse make when educating a patient with hyperthyroidism with an upcoming thyroidectomy?

A. “After surgery, notify your nurse if you have any tingling sensations.”

B. “You should limit your daily caffeine intake to 200 to 300 mg.”

C. “You will need to eat 4 000 calories per day after surgery.”

D. “After surgery, you will need to consume high amounts of iodine.”

Answer 22

A. “After surgery, notify your nurse if you have any tingling sensations.”
After surgery, patients must be monitored for signs of tetany which indicates hypocalcemia. These signs include a tingling sensation, muscle twitching, and apprehension.

Question 23

After a hypophysectomy for acromegaly, which of the following should be the focus of postoperative nursing care?

a. Frequent monitoring of serum and urine osmolality

b. Parenteral administration of a GH-receptor antagonist

c. Keeping the client in a recumbent position at all times

d. Client teaching regarding the need for lifelong hormone therapy

Answer 23

A.

Question 24

A client with a head injury develops SIADH. Which of the following manifestations of SIADH would the nurse expect to find?

a. Hypernatremia and edema

b. Muscle spasticity and hypertension

c. Low urine output and hyponatremia

d. Weight gain and decreased glomerular filtration rate (GFR)

Answer 24

C.

Question 25

The health care provider prescribes levothyroxine (Synthroid) for a client with myxedema. After teaching regarding this medication, the nurse determines that further instruction is needed when the client says which of the following?

a. “I can expect the medication dose may need to be adjusted.”

b. “I only need to take this medication until my symptoms are improved.”

c. “I can expect to return to normal function with the use of this medication.”

d. “I will report any chest pain or difficulty breathing to the doctor right away.”

Answer 25

B.

Question 26

Which of the following symptoms would lead the nurse to suspect damage or removal of the parathyroid glands after thyroid surgery?

a. Muscle weakness and weight loss

b. Hyperthermia and severe tachycardia

c. Hypertension and difficulty swallowing

d. Laryngospasms and tingling in the hands and feet

Answer 26

D.

Question 27

Which of the following are important nursing intervention(s) when caring for a client with Cushing’s syndrome? (Select all that apply.)

a. Restricting protein intake

b. Monitoring blood glucose levels

c. Observing for signs of hypotension

d. Administering medication in equal doses

e. Protecting the client from exposure to infection

Answer 27

B, E.

Question 28

Which of the following is an important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism?

a. Monitor blood glucose levels.

b. Restrict fluid and sodium intake.

c. Administer potassium-sparing diuretics.

d. Advise the client to make postural changes slowly.

Answer 28

C.

Question 29

How does the nurse instruct the client who is taking corticosteroids to control the adverse effects of medication therapy?

a. Increase calcium intake to 1500 mg/day.

b. Perform glucose monitoring for hypoglycemia.

c. Obtain immunizations due to high risk for infections.

d. Avoid abrupt position changes because of the risk for orthostatic hypotension.

Answer 29

A.

Question 30

What does the nurse teach the client regarding the best time to take corticosteroids for replacement purposes?

a. Once a day at bedtime

b. Every other day on awakening

c. On arising and in the late afternoon

d. At consistent intervals every 6 to 8 hours

Answer 30

C.