Chapter 47: Thyroid and Parathyroid Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain,
muscle aches and pains, and constipation. Which laboratory test results will help confirm the
diagnosis of hypothyroidism?
a.
Both tests show decreases.
b.
Both tests show increases.
c.
The T3 test elevates, and the T4 test decreases.
d.
The level of thyroxin rises and then falls back to subnormal levels.
2. Which instruction should a nurse provide when a patient starts taking a saturated solution of
potassium iodide (SSKI)?
a.
Sip medication through a straw to prevent tooth staining.
b.
Double the dose if a dose is missed.
c.
Expect excessive salivation.
d.
Take before meals.
3. A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. What is the
best suggestion by the nurse?
a.
Taking “cat naps” during the day
b.
Adhering to a bedtime ritual
c.
Drinking a cup of cocoa before bedtime
d.
Performing mild prebedtime exercises
4. Which significant need should be included in instructions to a patient scheduled for a thyroid
scan (123I)?
a.
Provision of a special container to collect urine for the next 24 hours
b.
Wear a protective apron to shield him or her from radiation for the next 24 hours
c.
Request that visitors keep a distance of at least 6 feet away for the next 24 hours
d.
Wash their hands with soap and water after every voiding for the next 24 hours
5. A patient asks about his laboratory test, which showed a high level of thyroid-stimulating
hormone (TSH) and a low level of T4. What is the most accurate explanation?
a.
“It means that you have an inconsistency in your thyroid tests, and you will need
more testing.”
b.
“I am sorry. You will have to ask your physician about your laboratory results. We
are not allowed to discuss them.”
c.
“The TSH is sending a message to your thyroid gland to increase production, but
your thyroid isn’t producing enough hormone.”
d.
“That means that you will have to go on hormone therapy for the rest of your life.”
6. A patient with exophthalmos is distressed about her appearance and asks when it will go
away. What is the best response by the nurse?
a.
It is not reversible.
b.
It can be disguised with sunglasses and makeup.
c.
It usually subsides after medication for hyperthyroidism is started.
d.
It can be minimized with plastic surgery to the eyelids.
7. A nurse is explaining Graves disease to a newly diagnosed patient. Which statement by the
nurse best clarifies the pathophysiologic changes of Graves disease?
a.
“Your thyroid gland is not producing enough hormones; consequently, you will
need replacement therapy.”
b.
“Your thyroid gland is overactive, but there are ways to treat it through medicine
or surgery.”
c.
“It’s an autoimmune disorder that has no satisfactory treatment.”
d.
“Graves disease is a temporary disorder that will gradually subside.”
8. A nurse assessing a patient 1 day after a subtotal thyroidectomy notes that the patient’s color
is poor, the pulse and respirations are rapid, and the patient feels warm to the touch. The
patient says that she feels frightened. What is the best initial implementation by the nurse?
a.
Tell her that there is nothing to be afraid of and stay to calm her.
b.
Ask her if she would like pain medication.
c.
Call the charge nurse; these are signs of a thyroid storm.
d.
Get a tracheostomy set at the bedside.
9. A patient has been given an antithyroid drug called propylthiouracil. What appropriate nursing
implementations should be included?
a.
Using special radioactive precautions for her urine for the first 24 hours
b.
Monitoring her vital signs and withholding the medications if her pulse is greater
than 100 beats/min
c.
Teaching her to watch for and report any signs and symptoms of hypothyroidism
or infections
d.
Keeping her on a low-calorie, low-protein diet
10. What is the most appropriate nursing diagnosis for the patient recently diagnosed with
hyperthyroidism?
a.
Hypothermia, related to increased metabolic processes
b.
Constipation, related to increased hormonal stimulation
c.
Disturbed body image, related to weight gain
d.
Disturbed sleep pattern, related to metabolic disturbance
11. A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. What
should the nurse’s instructions relative to hormone replacement include?
a.
“Be certain that no dose is skipped.”
b.
“Be sure and take these drugs just before bedtime.”
c.
“Know the signs and symptoms of hyperthyroidism.”
d.
“You will be able to notice the benefits of thyroid replacement therapy right
away.”
12. What patient recommendation should a nurse include when preparing to present presurgical
teaching of a patient scheduled for a subtotal thyroidectomy?
a.
Lie flat on her back for 24 hours to prevent undue strain on the suture line.
b.
Be able to verbalize the signs and symptoms of thyroid crisis.
c.
Demonstrate how to deep breathe and support her head during position changes.
d.
Have a tube in her trachea to assist in breathing.
13. On returning from surgery after undergoing a thyroidectomy, a patient is alarmed about the
large tracheostomy tray on the bedside table. What is the nurse’s most reassuring response
when the patient asks why it is there?
a.
“We have it there as a precautionary measure in the unlikely event that you have
difficulty breathing.”
b.
“If you start bleeding, we’ll be able to take care of it right here at the bedside.”
c.
“We have to keep it there in case of an emergency and the physician needs it.”
d.
“It’s hospital policy to have it available for persons who are likely to have
respiratory arrest.”
14. What is the appropriate action of the nurse when assessing for hemorrhage in a
postthyroidectomy patient?
a.
Assess upper chest for the patient positioned in high Fowler position.
b.
Turn the patient to the side to check; the patient must be kept flat in the bed.
c.
Lift up the neck dressing to assess for excessive bleeding.
d.
Examine behind patient’s neck and upper back to assess for hemorrhage.
15. How do foods such as soybeans, turnips, and rutabagas affect people with thyroid disorders?
a.
Suppress thyroid hormone.
b.
Decrease the hypothermia of the person with hypothyroidism.
c.
Supplement the diet of a person with hypothyroidism.
d.
Counteract the effect of iodide therapy.
16. An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she
has taken for 15 years, has been reduced. What is nurse’s best rationale when explaining what
the decreased dose is related to?
a.
Improved efficacy of the thyroid preparation
b.
Age-related reduction in metabolic rate
c.
Drug-related hypertrophy of the thyroid
d.
Changes in your diet and activity level
17. A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier
notes that the patient’s hand goes into a carpopedal spasm. What should the nurse recognize
this movement as an indication of?
a.
Hyperkalemia, called the Allen sign
b.
Hypernatremia, called the Hogan sign
c.
Hypocalcemia, called the Trousseau sign
d.
Hypokalemia, called the Chvostek sign
18. What action should a nurse implement to address the nursing diagnosis, “Risk for impaired
skin integrity, related to dry skin” in the patient with hypothyroidism?
a.
Increase the frequency of bathing to get rid of dry skin.
b.
Apply lotions and creams to help maintain moisture.
c.
Increase activities to stimulate circulation in the skin.
d.
Take antihistamines to prevent itching.
19. What action should a nurse implement to initiate the Chvostek sign?
a.
Ask the patient to grimace and note if the facial response is symmetrical.
b.
Inflate a blood pressure cuff to the systolic level and watch for a carpopedal spasm.
c.
Tap the face over the facial nerve and watch for a spasm of the facial muscle.
d.
Check the pupillary response to light and determine whether the pupil
accommodates and reacts.
20. What symptoms should a nurse anticipate in the history of a patient with
hyperparathyroidism?
a.
Fatigue, hyperactive reflexes, muscle cramps, and twitching
b.
Poor muscle tone, bone pain, urinary calculi, and fractures
c.
Hunger, thirst, and urinary retention
d.
Tachycardia, air hunger, and nervousness
21. A patient being treated for hyperparathyroidism is to receive calcitonin (Calcimar). Which
patient assessment should occur before this medication is administered?
a.
Assessment for hydration status
b.
Evaluation for cardiac dysrhythmia
c.
Test for sensitivity
d.
Radiography for the presence of urinary calculi
22. What is an appropriate nursing diagnosis for a patient with hyperparathyroidism?
a.
Impaired urinary elimination, related to urinary calculi
b.
Decreased cardiac output, related to heart failure secondary to hypocalcemia
c.
Risk for injury, related to hypocalcemia leading to muscle spasms and convulsions
d.
Imbalanced nutrition: Greater than body requirements, related to increased appetite
23. What is the nurse aware is happening when the patient with hypoparathyroidism complains of
fatigue and a lack of energy?
a.
Hypertension is the cause of the fatigue.
b.
Hypocalcemia has caused decreased cardiac output.
c.
Dyspnea has sapped the patient’s energy.
d.
Poor muscle tone makes any activity tiring.
24. Why should a nurse recommend the use of salt that is iodized when providing dietary
education to patients?
a.
It prevents the development of goiter in adults and cretinism in infants.
b.
It can help prevent hypothyroidism.
c.
It is instrumental in preventing tumors of the parathyroid gland.
d.
It works as an important component of thyroid replacement therapy.
25. Which intervention is necessary to assist a patient with hypothyroidism to understand how he
can live a full and normal life?
a.
Teach the importance of taking antithyroid medication until it is no longer needed.
b.
Encourage exercise to burn extra calories and maintain a normal weight.
c.
Teach him to take care of energy needs through adequate nutrition.
d.
Encourage treatment with thyroid replacement therapy.
MULTIPLE RESPONSE
26. Why are antithyroid medications provided presurgically to a patient with hyperthyroidism?
(Select all that apply.)
a.
To decrease the level of hormone in the blood before surgery
b.
To help reduce the risk of hemorrhage during surgery
c.
To decrease the threat of a thyroid storm
d.
To reduce exophthalmia
e.
To increase weight
27. What should a nurse caring for a patient with hyperthyroidism include when developing a
plan of care? (Select all that apply.)
a.
Decreasing weight
b.
Provision of a cool environment
c.
Eye care
d.
Nutritional support
e.
Prevention of diarrhea
28. A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a
thionamide drug, should report. What should this list include? (Select all that apply.)
a.
Becoming pregnant
b.
Jaundice
c.
Blood in the stool
d.
Rash
e.
Urine retention
29. Why is hypothyroidism frequently overlooked in older adults? (Select all that apply.)
a.
Signs and symptoms are subtle.
b.
Signs and symptoms are discounted as age-related changes.
c.
Weight changes in the older adult are not pronounced.
d.
Older adults are not susceptible to thyroid disorders.
e.
Decrease in mental function is attributed to dementia.
COMPLETION
30. To meet the nutritional needs of a patient with Graves disease, the nurse recommends a diet of
_____ to _____ calories.
31. Congenital hypothyroidism, if left untreated, will result in _____.