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

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

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

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?
   1. Blurred and double vision
   2. Increased thirst and urination
   3. Profuse nausea and diarrhea
   4. Decreased attention and insomnia

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.

DIF:     Applying/Application                         REF: 1286                   KEY: Thyroid gland disorder| medication safety                                            MSC:                         Integrated Process: Nursing Process: Evaluation                                         NOT:                          Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
   1. Reassure the client that the voice change is temporary.
   2. Document the finding and assess the client hourly.
   3. Place the client in high-Fowler’s position and apply oxygen.
   4. Contact the provider and prepare for intubation.

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.

DIF:     Applying/Application                         REF: 1290                   KEY: Thyroid gland disorder| postoperative nursing| emergency nursing  MSC:                             Integrated Process: Nursing Process: Implementation                                 NOT:                          Client Needs Category: Safe and Effective Care Environment: Management of Care

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?
   1. Offer mouth care.
   2. Loosen the dressing.
   3. Assess for Chvostek’s sign.
   4. Ask the client orientation questions.

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 Chvostek’s sign and Trousseau’s 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.

DIF:            Applying/Application                         REF:    1297                 KEY: Thyroid gland disorder| postoperative nursing| emergency nursing| electrolyte imbalance           MSC: Integrated Process: Nursing Process: Assessment NOT:                                   Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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?
   1. “My sister has thyroid problems.”
   2. “I seem to feel the heat more than other people.”
   3. “Food just doesn’t taste good without a lot of salt.”
   4. “I am always tired, even with 12 hours of sleep.”

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.

DIF:            Applying/Application                         REF:    1292                 KEY: Thyroid gland disorder| assessment/diagnostic examination                        MSC: Integrated Process: Nursing Process: Assessment                      NOT:                                                 Client Needs Category: Physiological Integrity: Physiological Adaptation

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?
   1. Atropine sulfate
   2. Levothyroxine sodium (Synthroid)
   3. Propranolol (Inderal)
   4. Epinephrine (Adrenalin)

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.

DIF:            Applying/Application                         REF:    1293

KEY:          Thyroid gland disorder| medications

MSC:          Integrated Process: Nursing Process: Implementation

NOT:          Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies