Thyroid & Parathyroid Disorders

Question 0

Thyroid & Parathyroid Disorders - Burke Textbook Chapter 35

A client is diagnosed as having a goiter. The nurse knows that this condition is primarily due to:

A. iodine deficiency.
B. excess thyroid stimulating hormone.
C. deficient calcium levels.
D. excess cortisol.

Answer 0

A. iodine deficiency.

Rationale:
Iodine is needed for the production of thyroid hormone. A decrease in this hormone causes the thyroid to enlarge, goiter, in order to increase the hormone production. Excess TSG causes hyperthyroidism but not a goiter. Deficient calcium and PTH causes hypoparathyroidism. Cushing’s syndrome results from excess cortisol.

Question 1

Thyroid & Parathyroid - Burke Textbook Chapter 35

In caring for a client who has had a subtotal thyroidectomy, the nurse should assess for the priority life-threatening complication of:

A. hemorrhage.
B. tetany.
C. dehydration.
D. laryngeal nerve damage.

Answer 1

A. hemorrhage.

Rationale:
Hemorrhage is life-threatening. Be sure to assess the dressing BEHIND THE NECK. Observe for edema and increased swallowing. Tetany due to decreased serum calcium levels usually occurs 1 to 7 days postop if the parathyroid were damaged. Dehydration does not occur during the immediate postop period and usually is not life-threateneing. The laryngeal nerve may be damaged during surgery, but this is not life-threatening.

Question 2

Thyroid & Parathyroid Disorders - Burke Textbook Chapter 35

Which of the following nursing interventions should be used when administering potassium iodine (SSKI) to a client with hyperthyroidism? (Select all that apply.)

A. Do not give with an antacid.
B. Ask about allergies to shellfish.
C. Do not give to clients with asthma.
D. Monitor for itching and rash.
E. Dilute in milk or juice.
F. Monitor for bradycardia

Answer 2

B. Ask about allergies to shellfish.
E. Dilute in milk or juice.
F. Monitor for bradycardia

Rationale:
Clients allergic to shellfish to, which contain iodine, cannot take potassium iodine (SSKI). SSKI should be mixed in milk or fruit juice, and clients should be monitored for bradycardia. Antacids do not interfere with its absorption. SSKI does not cause rash or itching, nor worsen asthma.

Question 3

Thyroid & Parathyroid Disorders - Burke Textbook Chapter 35

A client is taking Synthroid (levothyroxine sodium) for 3 months. Which evaluation would indicate a therapeutic response to this drug?

A. decreased appetite
B. decreased diarrhea
C. normal heart rate
D. weight loss of 5 lbs

Answer 3

C. normal heart rate

Question 4

Thyroid & Parathyroid Disorders - Burke Textbook Chapter 35

Which one of these nursing actions is the highest priority for a client admitted with acute hypoparathyroidism?

A. Provide a quiet, dimly lighted room.
B. Assess for abdominal cramps.
C. Provide a diet high in calcium.
D. Assess for a patent airway.

Answer 4

D. Assess for a patent airway.

Rationale:
Hypoparathyroidism is cause bronchospasm and laryngeal spasms leading to respiratory distress. It is most important to ensure a patent airway first. All other interventions are important, but not the highest priority for this client.

Question 5

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

The nursing intervention that has the highest priority for the client who has undergone a subtotal thyroidectomy should be:

A. assess for hemorrhage.
B. assess for absent bowel sounds.
C. assess for calcium deficiency.
D. assess for laryngeal nerve damage.

Answer 5

A. assess for hemorrhage.

Question 6

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Mr. Tracy was diagnosed with hyperthyroidism 15 years ago. Recently he has been experiencing difficulty breathing and swallowing. You suspect:

A. thyroid cancer.
B. hyperparathyroidism.
C. hypocalcemia.
D. stroke.

Answer 6

A. thyroid cancer.

Question 7

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

The term euthyroid is used to describe:

A. balanced thyroid.
B. hyperthyroidism.
C. hypothyroidism.
D. Graves’ disease.

Answer 7

A. balanced thyroid.

Question 9

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Treatment for hypothyroidism is:

A. 500 mL of normal saline.
B. lifelong.
C. vitamin D.
D. short term.

Answer 9

B. lifelong.

Question 10

Thyroid & Parathyroid Disorders - ATI Med Surge Book Chapter 76

A 35-year-old client visits the outpatient clinic with symptoms of insomnia, anxiety, and feeling as though her heart is “racing.” The client has lost 6.7 kg (14.7 lb) over the past 3 weeks without dieting. Vital signs are: BP 152/92 mm Hg, pulse 122/min, and respirations 24/min. She also reports not being able to tolerate the heat and a decrease in her menstrual flow. The provider suspects Graves’ disease.

Which of the following laboratory test results should the nurse expect?

A. Decreased T3
B. Decreased FTI
C. Decreased TSH
D. Decreased TSH-RAb

Answer 10

C. Decreased TSH

Rationale:
A client who has Graves’ disease will have a decreased TSH due to elevated serum thyroid hormone. T3, FTI, and TSH-RAb will all be elevated.

Question 11

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Mrs. Kay presents with a temperature of 101ºF, malaise, and decreased lung sounds. She has a prescription for L-thyroxine, but tells you that she cannot afford the medication. During the assessment, she rapidly progresses to confusion and subsequently becomes unresponsive. You suspect that Mrs. Kay will be diagnosed with:

A. thyroiditis.
B. severe bronchitis.
C. myxedema.
D. sepsis

Answer 11

C. myxedema.

Question 12

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Hypercalcemia may lead to kidney stones, which are also known as:

A. calculi.
B. boils.
C. striations.
D. cysts.

Answer 12

A. calculi.

Question 13

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

An elderly woman with hyperparathyroidism is also likely to have:

A. hypophosphatemia.
B. hyponatremia.
C. hypercalcemia.
D. osteomyelitis.

Answer 13

C. hypercalcemia.

Question 14

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Nursing care of the client with hypoparathyroidism must consider the client’s risk for injury due to:

A. falls.
B. tetany.
C. altered thought processes.
D. impaired memory.

Answer 14

B. tetany

Question 15

Thyroid & Parathyroid Disorders - ATI Med Surge Book Chapter 76

The client is diagnosed with hyperthyroidism. Which of the following clinical manifestations of hyperthyroidism should the nurse expect to find? (Select all that apply.)

A. Excessive sweating
B. Tremors
C. Gastric hypermotility
D. Increase WBC count
E. Hypothermia
F. Photophobia
G. Exopthalmus

Answer 15

A. Excessive sweating
B. Tremors
C. Gastric hypermotility
F. Photophobia
G. Exopthalmus

Question 16

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

The first priority for treating hypoparathyroidism is to administer:

A. 500 mL of normal saline.
B. calcium gluconate.
C. vitamin D.
D. calciferol.

Answer 16

B. calcium gluconate.

Question 17

Thyroid & Parathyroid Disorders - Burke Workbook Chapter 35

Mrs. Kim has been complaining of lower back pain for 6 moths. Today her labs show elevated levels of serum calcium, PTH and alkaline phosphatase. These manifestations confirm a diagnosis of:

A. stroke.
B. hypocalcemia
C. hyperparathyroidism.
D. thyroid cancer.

Answer 17

C. hyperparathyroidism.

Question 18

Thyroid & Parathyroid Disorders - ATI Med Surge Book Chapter 76

The provider prescribes medication for the client’s hyperthyroidism. Which of the following medications blocks the synthesis of thyroid hormone?

A. Propylthiouracil (PTU)
B. Metoprolol (Lopressor)
C. Amoxicillin (Amoxil)
D. Docusate sodium (Colace)

Answer 18

A. Propylthiouracil (PTU)

Question 19

Thyroid & Parathyroid Disorders - ATI Med Surge Book Chapter 76

A 32-year-old client visits the outpatient clinic symptoms of fatigue, cold intolerance, dry scaly skin, hoarseness, weight gain, and fluid retention, based on these symptoms, thyroid studies are performed and reveal an elevated thyroid stimulating hormone (TSH) and decreased T3 and T4 levels. The provider prescribes levothyroxine sodium (Synthroid) 0.1 mg by mouth daily and instructs the client to return to the clinic in 1 mouth to have a TSH drawn.

A nurse caring for the client recognizes that the client’s TSH is a reliable indicator or the efficacy of the levothyroxine sodium because the TSH will

A. have a value of zero when an euthyroid state is re-established.
B. return to its expected reference range when an euthyroid state is re-established.
C. increase above its expected reference range when a therapeutic medication level is reached.
D. decrease below its expected reference range when a therapeutic medication level is reached.

Answer 19

B. return to its expected reference range when an euthyroid state is re-established.

Question 20

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

508. A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medicaiton has been prescribed to:

A. Treat thyroid storm
B. Prevent cardiac irritability
C. Treat hypocalcemic tetany
D. Stimulate the release of parathyroid hormone.

Answer 20

C. Treat hypocalcemic tetany

Test-taking strategy:
Noting the name of the medications (calcium gluconate) should easily direct you to option C.

Question 21

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

509. A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate?

A. Check for signs of bleeding.
B. Administer calcium gluconate.
C. Notify the register nurse immediately.
D. Reassure the client that this is usually a temporary condition.

Answer 21

D. Reassure the client that this is usually a temporary condition.

Test-taking Strategy:
Use the process of elimination. Options A and B can easily be eliminated, because they are unrelated to the signs presented in the questions. From the remaining options, recall that these signs indicate a temporary condition.

Question 22

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

510. A client is admitted to the emergency department and a diagnosis of myxedema coma is made. Which nursing action would the nurse prepare to carry out initially?

A. Warm the client.
B. Maintain a patent airway.
C. Infuse intravenous fluids
D. Administer thyroid hormone.

Answer 22

B. Maintain a patent airway.

Test-Taking Strategy:
Note the strategic words “carry out initially.” All of the options are appropriate interventions, but the use of ABCs—airway, breathing, and circulation—will direct you to option B.

Question 23

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

527. A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. The nurse understands that which of the following is a manifestation associated with this disorder?

A. Bradycardia
B. Hypertension
C. Constipation
D. Hypothermia

Answer 23

B. Hypertension

Question 24

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

531. What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves’ disease?

A. Provide a high-fiber diet.
B. Provide a restful environment.
C. Provide three small meals per day.
D. Provide the client with extra blankets.

Answer 24

B. Provide a restful environment.

Test-taking Strategy:
The strategic concept to bear in mind when answering this questions is that clients with Graves’ disease experience an accelerated metabolic rate. This concept should assist you with eliminating options A, C, and D.

Question 25

Thyroid & Parathyroid Disorders - Saunders NCLEX-PN Review Chapter 44

A nurse is caring for a postoperative parathyroidectomy client. Which of the following would require the nurse’s immediate attention?

A. Incisional pain
B. Laryngeal stridor
C. Difficulty voiding
D. Abdominal cramps.

Answer 25

B. Laryngeal stridor

Test-taking strategy:
Consider the anatomical location of the surgical procedure, and use the ABCs—airway, breathing, and circulation—to select the correct option. Options A, C, and D are usual postoperative problems that are not life threatening. Option B addresses the airway.

Question 26

Diabetes - ATI Med Surge Book (Chapter 74)

A nurse is reviewing the laboratory tests for a client who has suspected hypothyroidism. A decrease of which of the following values indicates that the client is experiencing a hypothyroid state? (Select all that apply.)

A. T3
B. T4
C. TSH
D. TRH
E. FSH

Answer 26

A. T3
B. T4

Rationale:
A client’s T3 and T4 usually decrease simultaneously with hypothyroidism. With a primary disease, the TSH will increase. The TRH will cause an increase o fTSH two-fold above the baseline with hypothyroidism.