Chapter 43 CC4Pt Thyroid and Parathyroid Disorders PDF

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Chapter 43 CC4Pt_Thyroid and Parathyroid Disorders.pdf...

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Chapter 43: Coordinating Care for Patients with Thyroid and Parathyroid Disorders MULTIPLE CHOICE 1. The nurse notes that a patient is diagnosed with Hashimoto’s thyroiditis. What is the most likely cause of this patient’s health problem? 1. Congenital 2. Iodine deficiency 3. Tyrosine deficiency 4. Autoimmune response ANS: 4 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 1. Describing the epidemiology of thyroid and parathyroid disorders Chapter page reference: 945 Heading: Hypothyroidism/Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Metabolism Difficulty: Moderate Feedback 1 2 3 4

One cause of primary hypothyroidism is a congenital thyroid disorder; however, this does not cause Hashimoto’s thyroiditis. Hypothyroidism can be caused by an iodine deficiency; however, this is rare because of iodized salt. Hypothyroidism can be caused by a tyrosine deficiency; however, this is rare because of iodized salt. Hashimoto’s thyroiditis is the most common type of hypothyroidism and is caused by an autoimmune response that leads to destruction of the thyroid gland by immunological processes.

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CON: Metabolism

2. A patient with hypothyroidism asks why the neck has become so large. What should the nurse respond to this patient? 1. “The growth is cancer.” 2. “The sluggish thyroid caused fat to be deposited around the neck.” 3. “The growth is the body’s attempt to wall off the infection in your thyroid.” 4. “The gland got larger because it was trying to make more thyroid hormone.” ANS: 4 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 1. Describing the epidemiology of thyroid and parathyroid disorders Chapter page reference: 945

Heading: Hypothyroidism/Epidemiology Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Metabolism Difficulty: Moderate Feedback 1 2 3 4

A goiter is not cancer. A goiter is not fat deposits. A goiter does not develop because of an infection of the thyroid gland. Hypothyroidism is a major cause of goiter and develops secondary to thyroid gland hypertrophy in an attempt to produce normal amounts of T3 and T4.

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CON: Metabolism

3. A patient with hypothyroidism is prescribed levothyroxine (Synthroid). At which time should the nurse schedule this medication to be administered? 1. 0800 hours 2. 1200 hours 3. 1700 hours 4. 2300 hours ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 4. Discussing the medical management of: Hypothyroidism Chapter page reference: 947 Heading: Hypothyroidism/Medical Management/Diagnosis Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 2 3 4

Because thyroid hormone affects metabolism, the medication is to be taken in the morning. This medication should be taken in the morning. This medication should be taken in the morning. This medication should be taken in the morning.

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CON: Medication

4. Which patient receiving levothyroxine requires close monitoring of vital signs during medication titration? 1. The patient with a history of anxiety 2. The patient with a history of depression 3. The patient with a history of cardiovascular disease 4. The patient with a history of inflammatory bowel disease

ANS: 3 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 5. Developing a comprehensive plan of nursing care for patients with thyroid and parathyroid disorders Chapter page reference: 947-948 Heading: Hypothyroidism/Medical Management/Medications/Safety Alert! Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Moderate Feedback 1 2 3

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The patient with a history of anxiety does not require close monitoring of vital signs during levothyroxine medication titration. The patient with a history of depression does not require close monitoring of vital signs during levothyroxine medication titration. In patients with a history of cardiovascular disease, the increases in dosage of levothyroxine are made cautiously because sudden increases in cardiac rate and contractility secondary to the medication may lead to angina or congestive heart failure. The patient with a history of inflammatory bowel disease does not require close monitoring of vital signs during levothyroxine medication titration.

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CON: Medication

5. The nurse correlates a husky voice in the patient with hypothyroidism to which assessment finding? 1. Chronic fatigue 2. Enlarged thyroid gland 3. Edema of the tongue and larynx 4. Dry mucous membranes from dehydration ANS: 3 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 5. Developing a comprehensive plan of nursing care for patients with thyroid and parathyroid disorders Chapter page reference: 948 Heading: Hypothyroidism/Nursing Management/Assessment and Analysis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 2

The husky voice is not caused by chronic fatigue. The husky voice is not caused by an enlarged thyroid gland.

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Edema of the tongue and around the larynx causes changes in speech resulting in a husky tone. The husky voice is not caused by dry mucous membranes or dehydration.

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CON: Assessment

6. The nurse is evaluating care provided to a patient with hypothyroidism. Which finding indicates that additional care is needed? 1. Warm skin 2. Heart rate 72 3. Blood pressure 118/68 mm Hg 4. Weight increase 2 kg over a month ANS: 4 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 6. Designing a plan of care that includes pharmacological, dietary, and lifestyle considerations for patients with thyroid and parathyroid disorders Chapter page reference: 949 Heading: Hypothyroidism/Nursing Management/Evaluating Care Outcomes Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 2 3 4

Normal skin turgor and texture are indicative of thyroid health in this patient population. Vital signs within normal limits indicates thyroid health. Vital signs within normal limits indicates thyroid health. Stable weight indicates thyroid health. A weight gain indicates a sluggish thyroid in this patient population.

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CON: Assessment

7. The nurse recognizes which disorder as the most common cause of hyperthyroidism? 1. Cancer 2. Toxic medications 3. Radiation exposure 4. Autoimmune disorder ANS: 4 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 1. Describing the epidemiology of thyroid and parathyroid disorders Chapter page reference: 949 Heading: Hyperthyroidism/Epidemiology

Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Knowledge [Remembering] Concept: Metabolism Difficulty: Easy Feedback 1 2 3 4

Cancer is not identified as a common cause for hyperthyroidism. Toxic medications are not identified as common causes for hyperthyroidism. Radiation exposure is not identified as a common cause for hyperthyroidism. Graves’s disease is the most common cause of hyperthyroidism and is an autoimmune disorder involving antibodies (thyroid-stimulating immunoglobulins) that bind to the thyroid gland, resulting in the enlargement of the thyroid gland and subsequent hypersecretion of thyroid hormone.

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CON: Metabolism

8. The nurse monitors for which clinical manifestation in the patient diagnosed with hyperthyroidism? 1. Insomnia 2. Bradycardia 3. Cold intolerance 4. Decreased appetite ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of hyperthyroidism. Chapter page reference: 949 Heading: Hyperthyroidism/Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 2 3 4

Insomnia is a clinical manifestation the nurse anticipates when assessing the patient who is diagnosed with hyperthyroidism. Tachycardia, not bradycardia, is a clinical manifestation the nurse anticipates when assessing the patient who is diagnosed with hyperthyroidism. Heat, not cold, intolerance is a clinical manifestation the nurse anticipates when assessing the patient who is diagnosed with hyperthyroidism. An increased, not decreased, appetite is a clinical manifestation the nurse anticipates when assessing the patient who is diagnosed with hyperthyroidism.

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CON: Assessment

9. A patient with hyperthyroidism is prescribed propylthiouracil (PTU). The nurse includes which formation about the mechanism of action of this medication in the teaching plan?

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Diverts iodine pathways Causes formation of thyroid antibodies Decreases the vascularity of the thyroid gland Blocks iodine from binding with thyroglobulin

ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 4. Discussing the medical management of: Hyperthyroidism Chapter page reference: 950-951 Heading: Hyperthyroidism/Medical Management/Medications/Table 43.3 – Pharmacological Management of Hyperthyroidism Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 2 3 4

Propylthiouracil (PTU) inhibits the synthesis of thyroid hormone by diverting iodine pathways. Lithium carbonate (Lithonate) can cause thyroid antibodies. Iodine decreases the vascularity of the thyroid gland. Methimazole (Tapazole) blocks the combination of iodine with a protein called thyroglobulin.

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CON: Medication

10. A patient is recovering from a thyroidectomy. Which observation needs to be reported immediately to the healthcare provider? 1. Changes in voice tone 2. Hypoactive bowel sounds 3. Blood pressure 138/70 mm Hg 4. Incisional pain ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 4. Discussing the medical management of: Hyperthyroidism Chapter page reference: 950-952 Heading: Hyperthyroidism/Surgical Management Integrated Processes: Communication and Documentation Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Perioperative Difficulty: Moderate Feedback 1

Assessing for damage to the laryngeal nerve is also a priority in the

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postoperative period after thyroidectomy. Changes in voice quality, particularly hoarseness or a husky tone, may be indicative of laryngeal nerve damage. Hypoactive bowel sounds could be caused by general anesthesia. Blood pressure of 138/70 mm Hg could be within normal limits for this patient. Postoperative pain would be expected in the perioperative period.

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CON: Perioperative

11. What is the priority action by the nurse in providing care to a patient diagnosed with thyrotoxicosis? 1. Monitoring heart rate 2. Managing the airway 3. Assessing blood pressure 4. Administering intravenous fluids ANS: 2 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 4. Discussing the medical management of hyperthyroidism. Chapter page reference: 952 Heading: Hyperthyroidism/Medical Management? Complications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Metabolism Difficulty: Difficult Feedback 1

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The nurse follows the ABCs (airway, breathing, circulation) to prioritize patient care. Although it is an appropriate nursing action to monitor the patient’s heart rate, this is not the priority because circulation is not prioritized over airway. Thyrotoxicosis is a medical emergency requiring definitive treatment to prevent respiratory compromise and cardiac collapse. The nurse follows the ABCs to prioritize patient care; therefore, the priority nursing action is to protect and manage the airway because intubation may be required. The nurse follows the ABCs to prioritize patient care. Although it is an appropriate nursing action to monitor the patient’s blood pressure, this is not the priority because circulation is not prioritized over airway. The nurse follows the ABCs to prioritize patient care. Although it is an appropriate nursing action to administer intravenous fluids, this is not the priority because circulation is not prioritized over airway.

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CON: Metabolism

12. A patient with hyperthyroidism is placed on seizure precautions as a result of which observation? 1. Serum sodium 120 mEq/L 2. Serum glucose 200 mg/dL 3. Rapid heart rate 4. Increased T3 and T4 levels

ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 6. Developing a comprehensive plan of nursing care for patients with thyroid and parathyroid disorders Chapter page reference: 952 Heading: Hyperthyroidism/Nursing Interventions/Assessments Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 2 3 4

The patient is at an increased risk for seizure activity related to hyponatremia. Hyperglycemia does not cause seizures. A rapid heart rate is a manifestation of hypermetabolism but will not directly cause seizures. Increased T3 and T4 levels are diagnostic for hyperthyroidism; however, they do not directly cause seizures.

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CON: Fluid and Electrolyte Balance

13. The nurse is preparing discharge instructions for a patient being treated medically for hyperthyroidism. What should the nurse emphasize to protect the patient’s eyes? 1. Use artificial tears. 2. Wear sunglasses at all times. 3. Wear eye shields at all times. 4. Tape the eyes closed at bedtime. ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 6. Designing a plan of care that includes pharmacological, dietary, and lifestyle considerations for patients with thyroid and parathyroid disorders Chapter page reference: 953 Heading: Hyperthyroidism/Nursing Interventions/Actions Integrated Processes: Teaching and Learning Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Metabolism Difficulty: Moderate Feedback 1 2 3 4

Eye lubricant decreases possible eye dryness and potential for corneal irritation secondary to incomplete eyelid closure. Sunglasses do not need to be worn at all times. Wearing eye shields at all times severely reduces this patient’s vision and would not be recommended. The eyes should not be taped shut.

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CON: Metabolism

14. A patient spontaneously develops manifestations of hypoparathyroidism. The nurse correlates which data from the patient’s history as the cause for this health problem? 1. Diabetes mellitus 2. Thyroid hypertrophy 3. Low intake of calcium-rich foods 4. Congenital absence of parathyroid glands ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 1. Describing the epidemiology of thyroid and parathyroid disorders Chapter page reference: 953-954 Heading: Hypoparathyroidism/Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Metabolism Difficulty: Moderate Feedback 1

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Autoimmune disease is suspected in patients with spontaneous presentation of hypoparathyroidism with no identifiable cause. In these cases, antiparathyroid antibodies have been detected in patients with other autoimmune disorders such as diabetes mellitus. Thyroid hypertrophy would cause hyperthyroidism. A low intake of calcium-rich foods does not cause hypoparathyroidism. The patient would have experienced symptoms at birth if the parathyroid glands were congenitally absent.

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CON: Metabolism

15. The nurse monitors for which clinical manifestations in the patient diagnosed with hypoparathyroidism? 1. Low heart rate 2. Muscle weakness 3. Respiratory rate 20 and shallow 4. Hand spasm ANS: 4 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of: Hypoparathyroidism Chapter page reference: 954-955 Heading: Hypoparathyroidism/Clinical Manifestations

Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1

The heart rate is not impacted by parathyroid hormone. Muscle weakness is not associated with hypoparathyroidism. A respiratory rate of 20 and shallow is not associated with hypoparathyroidism. A hand spasm when measuring blood pressure indicates Trousseau’s sign.

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CON: Assessment

16. The nurse correlates which laboratory value to a patient diagnosed with hypoparathyroidism? 1. Serum phosphate 5.5 mg/dL 2. Serum magnesium 3.0 mg/dL 3. Serum potassium 3.2 mEq/L 4. Serum albumin 4.0 g/dL ANS: 1 Chapter number and title: 43, Coordinating Care for Patients with Thyroid and Parathyroid Disorders Chapter learning objective: 3. Describing the diagnostic results used to confirm the diagnoses of thyroid and parathyroid disorders Chapter page reference: 955 Heading: Hypoparathyroidism/Medical Management/Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Difficult Feedback 1

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Diagnostic results consistent with hypoparat...