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Chapter 66: Care of Patients with Problems of the Thyroid and Parathyroid Glands

Test Bank
MULTIPLE CHOICE
1. A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal

thyroid-stimulating hormone (TSH) levels. Which is the nurse’s priority intervention?
Administer levothyroxine (Synthroid).
Administer propranolol (Inderal).
Monitor the apical pulse.
Assess for Trousseau’s sign.

a.
b.
c.
d.

ANS: C

The client’s laboratory findings suggest that the client is experiencing hyperthyroidism. The
increased metabolic rate can cause an increase in the client’s heart rate, and the client should
be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor
might also be a precaution. Synthroid is given for hypothyroidism. Propranolol is a beta
blocker often used to lower sympathetic nervous system activity in hyperthyroidism.
Trousseau’s sign is a test for hypocalcemia.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—
Expected Actions/Outcomes)
MSC: Integrated Process: Nursing Process (Implementation)
2. Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?
a. “You will have external beam radiation.”
b. “No radiation is used for this scan.”
c. “No special radiation precautions are needed.”
d. “Your thyroid will be radioactive for weeks.”
ANS: C

The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life
that the client is not considered to be a radiation hazard. Thus, no radiation precautions are
necessary. The other statements are inaccurate.
DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1396
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Diagnostic Tests)
MSC:
Integrated Process: Teaching/Learning
3. Which dietary modification does the nurse provide for a client with hyperthyroidism?
a. Decreased calories and proteins and increased carbohydrates
b. Elimination of carbohydrates and increased proteins and fats
c. Increased calories, proteins, and carbohydrates
d. Supplemental vitamins and reduction of calories
ANS: C

The client is hypermetabolic and has an increased need for calories, carbohydrates, and
proteins. Proteins are especially important because the client is at risk for a negative nitrogen
balance. The other modifications are inappropriate for a client with hyperthyroidism.

” “It will prevent excessive bleeding during surgery.” “It is given to stimulate the storage of excess thyroid hormones. Which is the nurse’s priority intervention? a. The other answers are not accurate. Which is the nurse’s best response? “Iodine will help make the internal surgical environment sterile. the client develops stridor. Which finding indicates that the client is having side effects of this therapy? a. Reassure the client that the voice change is temporary. Document the finding and assess the client hourly. This might be a physician function. Increased thirst and urination c. reducing the risk for hemorrhage and the potential for thyroid storm during surgery. One emergency measure is to remove the surgical clips to relieve the pressure. c. ANS: D Iodine preparations decrease the size and vascularity of the thyroid gland. b. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Twelve hours after a total thyroidectomy. DIF: Cognitive Level: Application/Applying or higher REF: N/A . ANS: D Stridor on exhalation is a hallmark of respiratory distress. Increased sweating and diarrhea d. Hyperextend the client’s neck and apply oxygen. The other choices are not specific to lithium. Blurred vision b.” a. d. A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Implementation) 6. b. A client with hyperthyroidism is taking lithium carbonate. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Adverse Effects/Contraindications/Side Effects/Interactions) MSC: Integrated Process: Nursing Process (Evaluation) 5.” “This will replace the hormones you will lose after your operation. Prepare for emergency tracheostomy and call the health care provider. c.DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Nursing Process (Implementation) 4. Decreased attention span and insomnia ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. d. The other choices do not address the emergency situation. usually caused by obstruction resulting from edema.

Thyroid problems are not inherited. Loss of taste is not a manifestation of hyperthyroidism. c. a. Assess Chvostek’s sign. c. Inderal is a beta blocker and would be contraindicated for a client with bradycardia. Then the nurse should notify the provider. “I seem to feel the heat more than other people. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) . Which client statement alerts the nurse to the possibility of hypothyroidism? a. b. The nurse should assess the client further by testing for Chvostek’s sign and Trousseau’s sign. Assess the client hourly. A client has been diagnosed with hypothyroidism. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 9. then atropine or epinephrine might be an option for short-term management. Loosen the dressing. d. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Analysis) 8.” ANS: D Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. d. even with 10 or 12 hours of sleep. Which is the nurse’s priority intervention? Offer mouth care.” d. “My sister has thyroid problems. If the heart rate were so slow that it became an emergency. The other choices do not address the emergency situation. which could progress to cause tetany and seizure activity. “Food just doesn’t taste good without a lot of salt. Which medication is the nurse prepared to administer to treat the client’s bradycardia? Atropine sulfate Levothyroxine sodium (Synthroid) Propranolol (Inderal) Epinephrine (Adrenalin) a. ANS: C Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia. On the second postoperative day after a subtotal thyroidectomy. the client tells the nurse that he feels numbness and tingling around his mouth. b. “I am always tired. Heat intolerance is indicative of hyperthyroidism.TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Medical Emergencies) MSC: Integrated Process: Nursing Process (Implementation) 7.” c. ANS: B The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium.” b.

Weight has been the same for 3 weeks.” c. Which is the nurse’s best response? a. A client has hypothyroidism and has been started on levothyroxine (Synthroid). b. confusion. Then you won’t need thyroid medication. The client will need lifelong thyroid replacement therapy. Lapses in memory and attention require the nurse to ensure that the client’s environment is safe. The client is often unmotivated to participate in self-care. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Evaluation) 12. ANS: D Hypothyroidism decreases body functioning and can result in effects such as bradycardia. you can stop the medication. The other answers are incorrect. a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. “When blood tests indicate normal thyroid function.MSC: Integrated Process: Nursing Process (Implementation) 10. If a client’s heart rate is bradycardic while on thyroid hormone replacement. this is an indicator that the replacement may not be adequate. d. Body image problems and weight issues do not take priority over mental status and safety. and constipation. The other assessment findings do not give any indication as to whether treatment is successful. Heat intolerance is seen in hyperthyroidism. d. The client’s family may have great difficulty accepting and dealing with these changes. “You will need to take the thyroid medication until the goiter is completely gone. Which assessment finding leads the nurse to conclude that the treatment is effective? Thirst is recognized and the client drinks fluids appropriately. a. A client with hypothyroidism as a result of Hashimoto’s thyroiditis asks the nurse how long she will have to take thyroid medication. ANS: C Hypothyroidism causes many problems in psychosocial functioning. “You’ll need thyroid pills for life because your thyroid won’t start working again. .” d.” b. “Thyroiditis is cured with antibiotics. c. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology) MSC: Integrated Process: Nursing Process (Analysis) 11. c. Depression is the most common reason for seeking medical attention. Heart rate is 70 beats/min and regular. Conversely. Memory and attention span may be impaired.” ANS: C Hashimoto’s thyroiditis results in a permanent loss of thyroid function. Which problem does the nurse address as a priority for this client? Heat intolerance Body image problems Depression and withdrawal Obesity a. b. A client has hypothyroidism. Total white blood cell count is 6000 cells/mm3.

Use a lift sheet to assist the client with position changes. reduces the risk of bone injury. Supporting the neck with movement and using a soft toothbrush are not needed for this client. a. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control— Accident/Injury Prevention) MSC: Integrated Process: Nursing Process (Implementation) 15. b. Strain all urine for at least 24 hours and send stones to the laboratory. 1405 TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Communication and Documentation 13. When taking the blood pressure of a client after a parathyroidectomy. Which client is at greatest risk for hyperparathyroidism? a. Instruct the client to use a soft-bristled toothbrush. c. The priority is preventing injury. 6.DIF: Cognitive Level: Comprehension/Understanding REF: p. DIF: Cognitive Level: Knowledge/Remembering REF: Table 66-3. They are chronically hypocalcemic. Serum sodium. 1406 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) 14.8 mEq/L c. Serum potassium. Older adult client on home oxygen therapy ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract.9 mg/dL ANS: D . and this triggers overstimulation of the parathyroid glands. Client receiving dialysis for end-stage kidney disease c. Client with pregnancy-induced hypertension b. Serum potassium. ANS: B Hyperparathyroidism causes increased resorption of calcium from the bones. 5. the nurse notes that the client’s hand has gone into flexion contractions. increasing the risk for pathologic fractures. d. Which intervention is the priority for the nurse to add to the client’s plan of care? Instruct the client to place both hands behind the neck when moving. 122 mEq/L d. Using a lift sheet when moving or positioning the client. Serum calcium. p.9 mEq/L b. 2. The other factors do not place a client at higher risk for hyperparathyroidism. A client has hyperparathyroidism. The nurse is reviewing client medical histories. Hyperparathyroidism can cause kidney stones. Older adult client with moderate heart failure d. but not every client will need to have urine strained. Which laboratory result does the nurse correlate with this condition? a. instead of pulling on the client.

. The nurse is assessing a client with Graves’ disease and finds that the client’s temperature has risen 1° F. I will be careful with activity. and if it is too fast.” a. I need to notify my health care provider immediately.” “Liver problems can occur with this drug so I need to report jaundice.” d. not the other electrolyte imbalances. spasms. 1394 TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology) MSC: Integrated Process: Teaching/Learning 18. and hyponatremia. which action by the nurse takes priority? a. The predisposition is probably polygenic and the client’s diabetes did not cause her daughter’s Graves’ disease. hyperkalemia. Graves’ disease is associated with diabetes.” ANS: B An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. and clients should not take it if they are pregnant. Which statement by the client indicates good understanding of teaching regarding this medication? “If I become pregnant. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. “An association has been noted between Graves’ disease and diabetes. but the fact that you have diabetes did not cause your daughter to have Graves’ disease. Liver problems can occur with propylthiouracil (PTU). The other statements are inaccurate. I will call my provider. and your diabetes could have led to your daughter having Graves’ disease. Turn the lights down in the client’s room and shut the door. so you can be certain that the fact that you have diabetes did not cause your daughter to have Graves’ disease. The client is receiving methimazole (Tapazole). Dyspnea and vertigo are not side effects of methimazole. “No connection is known between Graves’ disease and diabetes. The client asks the nurse if she is responsible for the fact that her daughter has Graves’ disease. The flexion contractions (Trousseau’s sign) that occur during blood pressure measurement are indicative of hypocalcemia.Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches. The client does not need to take his or her pulse daily. Before notifying the health care provider. ANS: A Methimazole can cause birth defects. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Analysis) 16. and tetany. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Nursing Process (Evaluation) 17. b.” c. “Unfortunately. which include hypokalemia.” “This medication may cause dyspnea or vertigo.” b. but not with a disease such as diabetes. A client has diabetes mellitus. DIF: Cognitive Level: Comprehension/Understanding REF: p. c. Her daughter has recently been diagnosed with Graves’ disease. “Graves’ disease is associated with autoimmune diseases such as rheumatoid arthritis.” “I will take my pulse daily. Which is the best response of the nurse? a. d.

A client being treated for hypothyroidism has been admitted for pneumonia. Call for an immediate electrocardiogram (ECG). maintaining an airway is a priority. Calculate the client’s apical-radial pulse deficit. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care— Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 19.b. and the provider needs to be notified. d. Which statement by the client indicates that further instruction is needed? “I may need calcium replacement after surgery. The nurse should ensure that suction is available in the client’s room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia. In this emergency situation. the client must be given thyroid replacement medication for life. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Nursing Process (Evaluation) 20. Assess vital signs every 4 hours. a. Administer acetaminophen (Tylenol) for fever. d. The nurse can then call for an ECG. ANS: C A client with hypothyroidism who develops another illness is at risk for myxedema coma. b. ANS: A A temperature increase of 1° F may indicate the development of thyroid storm. d. He or she may also need calcium if the parathyroid is damaged during surgery and can receive pain medication postoperatively. A client has undergone a complete thyroidectomy. Before notifying the provider. Which activity does the nurse include as a priority in this client’s care plan? Monitor the client’s IV site every shift. Ensure that working suction equipment is in the room. c.” a. ANS: B After the client undergoes a thyroidectomy. and Tylenol is not needed because the temperature increase is due to thyroid activity. I won’t need to take thyroid medication. the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. b. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Analysis) .” “After surgery. The apical-radial pulse deficit would not be necessary. c.” “I can receive pain medication if I feel that I need it. but having suction available is a safety feature for this client. Administer a dose of acetaminophen (Tylenol).” “I’ll need to take thyroid hormones for life. c.

The client’s sodium level is normal. Potassium chloride orally b. so calcitriol is not needed. The potassium level is high. A client has been admitted with hypoparathyroidism.) a. No information about a vitamin D deficiency is available. 144 mEq/L. 7. magnesium. D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate).2 mEq/L. 3% NS IV solution d. potassium. 50% magnesium sulfate e.2 mg/dL.MULTIPLE RESPONSE 1. Which medications does the nurse anticipate administering? (Select all that apply. 5. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Analysis) . 1. The client’s serum laboratory values are as follows: calcium.7 mEq/L. so hypertonic IV solution is not needed. so replacement is not needed. sodium. Calcitriol (Rocaltrol) orally ANS: B. Calcium chloride IV c.