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Exam 4: Thyroid Disorder (NCLEX)
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A nurse is collecting data regarding a client after a thyroidectomy
4
and notes that the client has developed hoarseness and a weak
Weakness and hoarseness of the voice can occur as a result of
voice. Which nursing action is appropriate?
trauma of the laryngeal nerve. If this develops, the client should be
reassured that the problem will subside in a few days. Unneces-
1. Check for signs of bleeding.
sary talking should be discouraged. It is not necessary to notify
2. Administer calcium gluconate.
the registered nurse immediately. These signs do not indicate
3. Notify the registered nurse immediately.
bleeding or the need to administer calcium gluconate.
4. Reassure the client that this is usually a temporary condition.
2
A nurse is caring for a postoperative parathyroidectomy client.
During the postoperative period, the nurse carefully observes
Which of the following would require the nurse's immediate at-
the client for signs of hemorrhage, which cause swelling and
tention?
the compression of adjacent tissue. Laryngeal stridor is a harsh,
high-pitched sound heard on inspiration and expiration that is
1. Incisional pain
caused by the compression of the trachea and that leads to
2. Laryngeal stridor
respiratory distress. It is an acute emergency situation that re-
3. Difficulty voiding
quires immediate attention to avoid the complete obstruction of
4. Abdominal cramps
the airway.
A nurse assists in developing a plan of care for a client with hyper-
3
parathyroidism receiving calcitonin-human (Cibacalcin). Which
Hypercalcemia can occur in clients with hyperparathyroidism, and
outcome has the highest priority regarding this medication?
calcitonin is used to lower plasma calcium level. The highest
priority outcome in this client situation would be a reduction in
1. Relief of pain
serum calcium level. Option 1 is unrelated to this medication.
2. Absence of side effects
Although options 2 and 4 are expected outcomes, they are not
3. Reaching normal serum calcium levels
the highest priority for administering this medication.
4. Verbalization of appropriate medication knowledge
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A nurse would expect to note which interventions in the plan of The clinical manifestations of hypothyroidism are the result of
care for a client with hypothyroidism? Select all that apply. decreased metabolism from low levels of thyroid hormone. Inter-
ventions are aimed at replacement of the hormones and providing
1. Provide a cool environment for the client. measures to support the signs and symptoms related to a de-
2. Instruct the client to consume a high-fat diet. creased metabolism. The nurse encourages the client to consume
3. Instruct the client about thyroid replacement therapy. a well-balanced diet that is low in fat for weight reduction and
4. Encourage the client to consume fluids and high-fiber foods in high in fluids and high-fiber foods to prevent constipation. The
the diet. client often has cold intolerance and requires a warm environment.
5. Instruct the client to contact the health care provider if episodes The client would notify the health care provider if chest pain
of chest pain occur. occurs since it could be an indication of overreplacement of thyroid
6. Inform the client that iodine preparations will be prescribed to hormone. Iodine preparations are used to treat hyperthyroidism.
treat the disorder. These medications decrease blood flow through the thyroid gland
and reduce the production and release of thyroid hormone.
A nurse is caring for a client after thyroidectomy and monitoring
2
for signs of thyroid storm. The nurse understands that which of
Clinical manifestations associated with thyroid storm include a
the following is a manifestation associated with this disorder?
fever as high as 106° F (41.1° C), severe tachycardia, profuse
diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hy-
1. Bradycardia
perreflexia, abdominal pain, diarrhea, and dehydration. With this
2. Hypotension
disorder, the client's condition can rapidly progress to coma and
3. Constipation
cardiovascular collapse.
4. Hypothermia
2
What would the nurse anticipate being included in the plan of care
Because of the hypermetabolic state, the client with Graves' dis-
for a client who has been diagnosed with Graves' disease?
ease needs to be provided with an environment that is restful both
physically and mentally. Six full meals a day that are well balanced
1. Provide a high-fiber diet.
and high in calories are required, because of the accelerated
2. Provide a restful environment.
metabolic rate. Foods that increase peristalsis (e.g., high-fiber
3. Provide three small meals per day.
foods) need to be avoided. These clients suffer from heat intol-
4. Provide the client with extra blankets.
erance and require a cool environment.
Which statement by the client would cause the nurse to suspect
1
that the thyroid test results drawn on the client this morning may
Option 1 indicates that a recent radionuclide scan had been
be inaccurate?
performed. Recent radionuclide scans performed before the test
can affect thyroid laboratory results. No food, fluid, or activity
1. "I had a radionuclide test done 3 days ago."
1 / 25
2. "When I exercise I sweat more than normal."
restrictions are required for this test, so options 2, 3, and 4 are
3. "I drank some water before the blood was drawn."
incorrect.
4. "That hamburger I ate before the test sure tasted good."
A nurse is caring for a client with a diagnosis of hypoparathy-
roidism. The nurse reviews the laboratory results drawn on the 1
client and notes that the calcium level is extremely low. The nurse Hypoparathyroidism is related to a lack of parathyroid hormone
would expect to note which of the following on data collection of secretion or to a decreased effectiveness of parathyroid hormone
the client? on target tissues. The end result of this disorder is hypocalcemia.
When serum calcium levels are critically low, the client may exhibit
1. Positive Trousseau's sign positive Chvostek's and Trousseau's signs, which indicate poten-
2. Negative Chvostek's sign tial tetany. Options 2, 3, and 4 are not related to the presence of
3. Unresponsive pupils hypocalcemia.
4. Hyperactive bowel sounds
A health care provider has prescribed propylthiouracil (PTU) for a
client with hyperthyroidism, and the nurse assists in developing
a plan of care for the client. A priority nursing measure to be 1
included in the plan regarding this medication is to monitor the Excessive dosing with propylthiouracil may convert the client from
client for: a hyperthyroid state to a hypothyroid state. If this occurs, the
dosage should be reduced. Temporary administration of thyroid
1. Signs and symptoms of hypothyroidism hormone may be required. Propylthiouracil is not used for pain
2. Signs and symptoms of hyperglycemia and does not cause hyperglycemia or renal toxicity.
3. Relief of pain
4. Signs of renal toxicity
4
Because photophobia (light intolerance) accompanies this disor-
A client with Graves' disease has exophthalmos and is experienc- der, dark glasses are helpful in alleviating the symptom. Medical
ing photophobia. Which intervention would best assist the client therapy for Graves' disease does not help alleviate the clinical
with this problem? manifestation of exophthalmos. Other interventions may be used
to relieve the drying that occurs from not being able to completely
1. Administering methimazole (Tapazole) every 8 hours close the eyes; however, the question is asking what the nurse can
2. Lubricating the eyes with tap water every 2 to 4 hours do for photophobia. Tap water, which is hypotonic, could actually
3. Instructing the client to avoid straining or heavy lifting cause more swelling to the eye because it could pull fluid into the
4. Obtaining dark glasses for the client interstitial space. In addition, the client is at risk for developing an
eye infection because the solution is not sterile. There is no need
to prevent straining with exophthalmos.
4
The nurse caring for a client who has had a subtotal thyroidectomy Hemorrhage is one of the most severe complications that can
reviews the plan of care and determines which problem is the occur following thyroidectomy. The nurse must frequently check
priority for this client in the immediate postoperative period? the neck dressing for bleeding and monitor vital signs to detect
early signs of hemorrhage, which could lead to shock. T3 and T4
1. Dehydration do not regulate fluid volumes in the body. Infection is a concern
2. Infection for any postoperative client but is not the priority in the immediate
3. Urinary retention postoperative period. Urinary retention can occur in postoperative
4. Bleeding clients as a result of medication and anesthesia but is not the
priority from the options provided.
A nurse is collecting data on a client admitted to the hospital with
a diagnosis of myxedema. Which data collection technique will 2
provide data necessary to support the admitting diagnosis? Inspection of facial features will reveal the characteristic coarse
features, presence of edema around the eyes and face, and a
1. Auscultation of lung sounds blank expression that are characteristic of myxedema. The tech-
2. Inspection of facial features niques in the remaining options will not reveal any data that would
3. Percussion of the thyroid gland support the diagnosis of myxedema.
4. Palpation of the adrenal glands
A nurse reviews a plan of care for a postoperative client following 3
a thyroidectomy and notes that the client is at risk for breathing Following a thyroidectomy, the client should be placed in an up-
difficulty. Which of the following nursing interventions will the nurse right position to facilitate air exchange. The nurse should assist the
suggest to include in the plan of care? client with deep breathing exercises, but coughing is minimized
to prevent tissue damage and stress to the incision. A pressure
1. Maintain a supine position. dressing is not placed on the operative site because it could
2. Encourage coughing and deep breathing exercises. affect breathing. The nurse should monitor the dressing closely
2 / 25
and should loosen the dressing if necessary. Neck circumference
3. Monitor neck circumference frequently.
is monitored at least every 4 hours to assess for postoperative
4. Maintain a pressure dressing on the operative site.
edema.
A nurse is monitoring a client following a thyroidectomy for signs
of hypocalcemia. Which of the following signs, if noted in the client, 1
likely indicates the presence of hypocalcemia? Following a thyroidectomy, the nurse assesses the client for signs
of hypocalcemia and tetany. Early signs include tingling around
1. Tingling around the mouth the mouth and fingertips, muscle twitching or spasms, palpitations
2. Negative Chvostek's sign or dysrhythmias, and positive Chvostek's and Trousseau's signs.
3. Flaccid paralysis Options 2, 3, and 4 are not signs of hypocalcemia.
4. Bradycardia
A nurse is caring for a client following a thyroidectomy. The client
tells the nurse that she is concerned because of voice hoarse-
ness. The client asks the nurse whether the hoarseness will sub- 4
side. The nurse appropriately tells the client that the hoarseness: Hoarseness that develops in the postoperative period is usually
the result of laryngeal pressure or edema and will resolve within
1. Indicates nerve damage a few days. The client should be reassured that the effects are
2. Is harmless but permanent transitory. Options 1, 2, and 3 are incorrect.
3. Will worsen before it subsides
4. Is normal and will gradually subside
A nurse is monitoring a client with Graves' disease for signs of
thyrotoxic crisis (thyroid storm). Which of the following signs and
234
symptoms, if noted in the client, will alert the nurse to the presence
Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threat-
of this crisis? Select all that apply.
ening state of extreme thyroid activity that represents a breakdown
in the body's tolerance to a chronic excess of thyroid hormones.
1. Bradycardia
The clinical manifestations include fever greater than 100° F,
2. Fever
severe tachycardia, flushing and sweating, and marked agitation
3. Sweating
and restlessness. Delirium and coma can occur.
4. Agitation
5. Pallor
Which of the following clients is at risk for developing thyrotoxico-
sis? 2
Thyrotoxicosis is usually seen in clients with Graves' disease with
1. A client with hypothyroidism the symptoms precipitated by a major stressor. This complication
2. A client with Graves' disease who is having surgery typically occurs during periods of severe physiological or psycho-
3. A client with diabetes mellitus scheduled for debridement of a logical stress such as trauma, sepsis, the birth process, or major
foot ulcer surgery. It also must be recognized as a potential complication
4. A client with diabetes insipidus scheduled for an invasive diag- following a thyroidectomy.
nostic test
2
A nurse is caring for a client diagnosed with hyperparathyroidism
The aim of treatment in the client with hyperparathyroidism is
who is prescribed furosemide (Lasix). The nurse reinforces di-
to increase the renal excretion of calcium and decrease gas-
etary instructions to the client. Which of the following is an appro-
trointestinal absorption and bone resorption. This is aided by the
priate instruction?
sufficient intake of fluids. Dietary restriction of calcium may be
used as a component of therapy. The parathyroid is responsible
1. Increase dietary intake of calcium.
for calcium production, and the term, "hyperparathyroidism" can
2. Drink at least 2 to 3 L of fluid daily.
be indicative of an increase in calcium. The client should eat foods
3. Eat sparely when experiencing nausea.
high in potassium, especially if the client is taking furosemide.
4. Decrease dietary intake of potassium.
Limiting nutrients is not advisable.
A nurse has reinforced instructions to the client with hyper-
parathyroidism regarding home care measures related to exer- 35
cise. Which statement by the client indicates a need for further The client should be instructed to avoid high-impact activity or
instruction? Select all that apply. contact sports such as football. Exercising late in the evening may
interfere with restful sleep. The client with hyperparathyroidism
1. "I enjoy exercising but I need to be careful." should pace activities throughout the day and plan for periods of
2. "I need to pace my activities throughout the day." uninterrupted rest. The client should plan for at least 30 minutes
3. "I need to limit playing football to only the weekends." of walking each day to support calcium movement into the bones.
4. "I should gauge my activity level by my energy level." The client should be instructed to use energy level as a guide to
5. "I should exercise in the evening to encourage a good sleep activity.
pattern."
3 / 25
A nurse has reinforced dietary instructions to a client with a
diagnosis of hypoparathyroidism. The nurse instructs the client to
1
include which of the following items in the diet?
The client with hypoparathyroidism is instructed to follow a cal-
cium-rich diet and to restrict the amount of phosphorus in the
1. Vegetables
diet. The client should limit meat, poultry, fish, eggs, cheese, and
2. Meat
cereals. Vegetables are allowed in the diet.
3. Fish
4. Cereals
4
Clients in thyroid storm are experiencing a life-threatening event,
A nurse is caring for a client experiencing thyroid storm. Which of
which is associated with uncontrolled hyperthyroidism. It is char-
the following would be a priority concern for this client?
acterized by high fever, severe tachycardia, delirium, dehydration,
and extreme irritability. The signs and symptoms of the disor-
1. Inability to cope with the treatment plan
der develop quickly, and therefore emergency measures must
2. Lack of sexual drive
be taken to prevent death. These measures include maintaining
3. Self-consciousness about body appearance
hemodynamic status and patency of airway as well as providing
4. Potential for cardiac disturbances
adequate ventilation. Options 1, 2, and 3 are not a priority in the
care of the client in thyroid storm.
A nurse is collecting data on a client with hyperparathyroidism.
2
Which of the following questions would elicit the accurate infor-
Hyperparathyroidism causes an oversecretion of parathyroid hor-
mation about this condition from the client?
mone (PTH), which causes excessive osteoblast growth and ac-
tivity within the bones. When bone reabsorption is increased,
1. "Do you have tremors in your hands?"
calcium is released from the bones into the blood, causing hyper-
2. "Are you experiencing pain in your joints?"
calcemia. The bones suffer demineralization as a result of calcium
3. "Have you had problems with diarrhea lately?"
loss, leading to bone and joint pain, and pathological fractures.
4. "Do you notice swelling in your legs at night?"
A client with myxedema has changes in intellectual function such
as impaired memory, decreased attention span, and lethargy. The
client's husband is upset and shares his concerns with the nurse.
4
Which statement by the nurse is helpful to the client's husband?
Using therapeutic communication techniques, the nurse acknowl-
edges the husband's concerns and conveys that the client's
1. "Would you like me to ask the health care provider for a
symptoms are common with myxedema. With thyroid hormone
prescription for a stimulant?"
therapy, these symptoms should decrease, and cognitive function
2. "Give it time. I've seen dozens of clients with this problem that
often returns to normal. Option 1 is not helpful, and it blocks further
fully recover."
communication. Option 3 is pessimistic and untrue. Option 2 is not
3. "I don't blame you for being frustrated, because the symptoms
appropriate and offers false reassurance.
will only get worse."
4. "It's obvious that you are concerned about your wife's condition,
but the symptoms may improve with continued therapy."
A client with hypoparathyroidism has hypocalcemia. The nurse
avoids giving the client the prescribed vitamin and calcium sup-
1
plement with which of the following liquids?
Milk products are high in phosphates, which should be avoided
by a client with hypoparathyroidism. Otherwise, calcium products
1. Milk
are best absorbed with milk because the vitamin D in the milk
2. Water
promotes calcium absorption.
3. Iced tea
4. Fruit juice
1
An older client with a history of hyperparathyroidism and severe
The client with severe osteoporosis as a result of hyperparathy-
osteoporosis is hospitalized. The nurse caring for the client plans
roidism is at risk for injury as a result of pathological fractures that
first to address which problem?
can occur from bone demineralization. The client may also have a
risk for constipation from the disease process but this is a lesser
1. The possibility of injury
priority than client safety. The client may or may not have urinary
2. Constipation
elimination problems, depending on other factors in the client's
3. Urinary retention
history. There is no information in the question to support whether
4. Need for teaching about the disorder
the client needs teaching.
A client has been diagnosed with hypoparathyroidism. The nurse 3
teaches the client to include foods in the diet that are: Hypoparathyroidism results in hypocalcemia. A therapeutic diet for
this disorder is one that is high in calcium but low in phosphorus
1. High in phosphorus and low in calcium because these two electrolytes have inverse proportions in the
4 / 25
2. Low in phosphorus and low in calcium
body. All of the other options are unrelated to this disorder and
3. Low in phosphorus and high in calcium
are incorrect.
4. High in phosphorus and high in calcium
A client scheduled for a thyroidectomy says to the nurse, "I am so
scared to get cut in my neck." Based on the client's statement, the
nurse determines that the client is experiencing which problem? 2
The client is having a difficult time coping with the scheduled
1. Inadequate knowledge about the surgical procedure surgery. The client is able to express fears but is scared. No data
2. Fear about impending surgery in the question support options 1, 3, and 4.
3. Embarrassment about the changes in personal appearance
4. Lack of support related to the surgical procedure
A nurse is collecting data on a client with a diagnosis of hy-
pothyroidism. Which of these behaviors, if present in the client's
history, would the nurse determine as being likely related to the 1
manifestations of this disorder? Hypothyroid clients experience a slow metabolic rate, and its
manifestation includes apathy, fatigue, sleepiness, and depres-
1. Depression sion. Options 2, 3, and 4 identify the clinical manifestations of
2. Nervousness hyperthyroidism.
3. Irritability
4. Anxiety
A nurse is caring for a client with hypothyroidism who is over-
2
weight. Which food items would the nurse suggest to include in
Clients with hypothyroidism may have a problem with being
the plan?
over-weight because of their decreased metabolic need. They
should consume foods from all food groups, which will provide
1. Peanut butter, avocado, and red meat
them with the necessary nutrients; however, the foods should be
2. Skim milk, apples, whole-grain bread, and cereal
low in calories. Option 2 is the only option that identifies food items
3. Organ meat, carrots, and skim milk
that are low in calories.
4. Seafood, spinach, and cream cheese
A nurse working on an endocrine nursing unit understands that
4
which correct concept is used in planning care?
Hyperparathyroidism is a disease that involves excess secretion
of parathyroid hormone (PTH). Elevation of PTH causes excess
1. Clients with Cushing's syndrome are likely to experience
calcium to be removed from the bones. There is a decline in
episodic hypotension.
bone mass, which may cause a fracture if a fall occurs. Cushing's
2. Clients with hyperthyroidism must be monitored for weight gain.
syndrome is likely to cause hypertension. Clients with hypothy-
3. Clients who have diabetes insipidus should be assessed for
roidism must be monitored for weight gain and clients with hyper-
fluid excess.
thyroidism must be monitored for weight loss. Clients who have
4. Clients who have hyperparathyroidism should be protected
diabetes insipidus should be assessed for fluid deficit.
against falls.
A nurse is collecting data from a client who is being admitted to the
hospital for a diagnostic workup for primary hyperparathyroidism. 2
The nurse understands that which client complaint would be Hypercalcemia is the hallmark of hyperparathyroidism. Elevated
characteristic of this disorder? serum calcium levels produce osmotic diuresis (polyuria). This
diuresis leads to dehydration and the client would lose weight.
1. Diarrhea Options 1, 3, and 4 are gastrointestinal (GI) symptoms but are
2. Polyuria not associated with the common GI symptoms typical of hyper-
3. Polyphagia parathyroidism (nausea, vomiting, anorexia, constipation).
4. Weight gain
A nurse is preparing to discharge a client who has had a parathy-
roidectomy. When teaching the client about the prescribed oral
calcium supplement, what information should the nurse include? 1
Oral calcium supplements can be taken 30 to 60 minutes after
1. Take the calcium 30 to 60 minutes following a meal. meals to enhance their absorption and decrease gastrointestinal
2. Avoid sunlight because it can cause skin color change. irritation. All the other options are unrelated to oral calcium ther-
3. Store the calcium in the refrigerator to maintain potency. apy.
4. Check the pulse daily and hold the dosage if it is below 60 beats
per minute.
A client has just been admitted with a diagnosis of myxedema
coma. If all of the following interventions were prescribed, the 1
nurse would place highest priority on completing which of the As part of maintaining a patent airway, oxygen would be admin-
following first?
5 / 25
1. Administering oxygen istered first. This would be quickly followed by fluid replacement,
2. Administering thyroid hormone keeping the client warm, monitoring vital signs, and administering
3. Warming the client thyroid hormones.
4. Giving fluid replacement
The client is diagnosed with hypothyroidism. Which signs/symp-
toms should the nurse expect the client to exhibit?
1. Complaints of extreme fatigue and hair loss. 1

2. Exophthalmos and complaints of nervousness.
3. Complaints of profuse sweating and flushed skin.
4. Tetany and complaints of stiffness of the hands.
The nurse identifies the client problem "risk for imbalanced body
temperature" fort he client diagnosed with hypothyroidism. Which
intervention should be included in the plan of care? 1
External heat sources (heating pads,electric or warming blankets)
1. Discourage the use of an electric blanket. should be discouraged because they increase the risk of periph-
2. Assess the client's temperature every two (2) hours. eral vasodilation and vascular collapse.
3. Keep the room temperature cool.
4. Space activities to promote rest.
The client diagnosed with hypothyroidism is prescribed the thy-
roid hormone levothyroxine (Synthroid). Which assessment data
indicate the medication has been effective? 3
The client with hypothyroidism frequently has a subnormal tem-
1. The client has a three (3)-pound weight gain. perature,so a temperature WNL indicates the medication is effec-
2. The client has a decreased pulse rate. tive.
3. The client's temperature is WNL.
4. The client denies any diaphoresis.
Which nursing intervention should be included in the plan of care
for the client diagnosed with hyperthyroidism?
4
The client with hyperthyroidism has an increased appetite; there-
1. Increase the amount of fiber in the diet.
fore, well-balanced meals served several times throughout the day
2. Encourage a low-calorie, low-protein diet.
will help with the client's constant hunger
3. Decrease the client's fluid intake to 1,000 mL/day.
4. Provide six (6) small, well-balanced meals a day.
The client is admitted to the intensive care department diagnosed
with myxedemacoma. Which assessment data warrant immediate
2
intervention by the nurse?
A pulse oximeter reading of less than 93% is significant. A 90%
pulse oximeter reading indicates a PaO2 of approximately 60 on
1. Serum blood glucose level of 74 mg/dL.
an arterial blood gas test; this is severe hypoxemia and requires
2. Pulse oximeter reading of 90%.
immediate intervention.
3. Telemetry reading showing sinus bradycardia.
4. The client is lethargic and sleeps all the time.
Which medication order should the nurse question in the client
diagnosed with untreated hypothyroidism?
3
Untreated hypothyroidism is characterized by an increased sus-
1. Thyroid hormones.
ceptibility to the effects of most hypnotic and sedative agents;
2. Oxygen.
therefore, the nurse should question this medication.
3. Sedatives.
4. Laxatives.
Which statement made by the client makes the nurse suspect the
client is experiencing hyperthyroidism?
4
The thyroid gland (in the neck) en-larges as a result of the in-
1. "I just don't seem to have any appetite anymore."
creased need for thyroid hormone production; an enlarged gland
2. "I have a bowel movement about every 3 to 4 days."
is called a goiter.
3. "My skin is really becoming dry and coarse."
4. "I have noticed all my collars are getting tighter."
The 68-year-old client diagnosed with hyperthyroidism is be-
ing treated with radio active iodine therapy. Which interventions
6 / 25
should the nurse discuss with the client?
1. Explain it will take up to a month for symptoms of hyperthy-

roidism to subside. 1
2. Teach the iodine therapy will have to be tapered slowly over one Radioactive iodine therapy is used to destroy the overactive thy-
(1) week. roid cells. After treatment, the client is followed closely for three
3. Discuss the client will have to be hospitalized during the ra- (3) to four (4) weeks until the euthyroid state is reached.
dioactive therapy.
4. Inform the client after therapy the client will not have to take any
medication.
The nurse is teaching the client diagnosed with hyperthyroidism. 1234
Which information should be taught to the client? Select all that Weight loss indicates the medication may not be effective and
apply. will probably need to be increased. The client needs to know
emotional highs and lows are secondary to hyperthyroidism. With
1. Notify the HCP if a three (3)-pound weight loss occurs in two treatment, this emotional lability will subside. Any over-the-counter
(2) days. medications (for example, alcohol-based medications) may nega-
2. Discuss ways to cope with the emotional lability. tively affect the client's hyperthyroidism or medications being used
3. Notify the HCP if taking over-the-counter medication for treatment. This will help any HCP immediately know of the
4. Carry a medical identification card or bracelet. client's condition, especially if the client is unable to tell the HCP.
5. Teach how to take thyroid medications correctly. The client will be on anti thyroid medication not thyroid medication
The nurse is providing an in-service on thyroid disorders. One of
the attendees asks the nurse, "Why don't the people in the United
States get goiters as often?" Which statement by the nurse is the
best response? 4
Almost all of the iodine entering the body is retained in the thyroid
1. "It is because of the screening techniques used in the United gland. A deficiency in iodine will cause the thyroid gland to work
States." hard and enlarge, which is called a goiter. Goiters are commonly
2. "It is a genetic predisposition rare in North Americans." seen in geographical regions having an iodine deficiency. Most
3. "The medications available in the United States decrease goi- table salt in the United States has iodine added.
ters."
4. "Iodized salt helps prevent the development of goiters in the
United States."
The nurse is preparing to administer the following medications.
Which medication should the nurse question administering?
1. The thyroid hormone to the client who does not have a T3, T4
3
level.
This potassium level is below normal,which is 3.5 to 5.5 mEq/L.
2. The regular insulin to the client with a blood glucose level of 210
Therefore,the nurse should question administering this medica-
mg/dL.
tion because loop diuretics cause potassium loss in the urine.
3. The loop diuretic to the client with a potassium level of 3.3
mEq/L.
4. The cardiac glycoside to the client who has a digoxin level of
1.4 mg/dL.
Which signs/symptoms should make the nurse suspect the client
is experiencing a thyroid storm?
2
Hyperpyrexia (high fever) and heart rate above 130 beats per
1. Obstipation and hypoactive bowel sounds.
minute are signs of thyroid storm, a severely exaggerated hyper-
2. Hyperpyrexia and extreme tachycardia.
thyroidism.
3. Hypotension and bradycardia.
4. Decreased respirations and hypoxia.
A client is admitted to an emergency department, and a diagnosis
of myxedema coma is made. Which action would the nurse pre-
pare to carry out initially?
2
1. Warm the client.
2.Maintain a patent airway.
3.Administer thyroid hormone.
4.Administer fluid replacement.
The nurse is preparing a client with a new diagnosis of hy-
pothyroidism for discharge. The nurse determines that the client
7 / 25
understands discharge instructions if the client states that which
symptoms are associated with this diagnosis? Select all that
apply.
1.Tremors
3456
2.Weight loss
3.Feeling cold
4.Loss of body hair
5.Persistent lethargy
6.Puffiness of the face
A client has been diagnosed with hyperthyroidism. Which signs
and symptoms may indicate thyroid storm, a complication of this
1245
disorder? Select all that apply.
Thyroid storm is an acute and life-threatening condition that oc-
curs in a client with uncontrollable hyperthyroidism. Symptoms
1.Fever
of thyroid storm include elevated temperature (fever), nausea,
2.Nausea
and tremors. In addition, as the condition progresses, the client
3.Lethargy
becomes confused. The client is restless and anxious and expe-
4.Tremors
riences tachycardia.
5.Confusion
6.Bradycardia
346
The clinical manifestations of hypothyroidism are the result of
The nurse should include which interventions in the plan of care
decreased metabolism from low levels of thyroid hormone. In-
for a client with hypothyroidism? Select all that apply.
terventions are aimed at replacement of the hormone and pro-
viding measures to support the signs and symptoms related to
1.Provide a cool environment for the client.
decreased metabolism. The client often has cold intolerance and
2.Instruct the client to consume a high-fat diet.
requires a warm environment. The nurse encourages the client to
3.Instruct the client about thyroid replacement therapy.
consume a well-balanced diet that is low in fat for weight reduction
4.Encourage the client to consume fluids and high-fiber foods in
and high in fluids and high-fiber foods to prevent constipation.
the diet.
Iodine preparations may be used to treat hyperthyroidism. Iodine
5.Inform the client that iodine preparations will be prescribed to
preparations decrease blood flow through the thyroid gland and
treat the disorder.
reduce the production and release of thyroid hormone; they are
6.Instruct the client to contact the health care provider (HCP) if
not used to treat hypothyroidism. The client is instructed to notify
episodes of chest pain occur
the HCP if chest pain occurs because it could be an indication of
over replacement of thyroid hormone.
A patient with Graves' disease is treated with iodine-131 (Iodope)
therapy. Which statement by the patient would indicate under-
C
standing of the treatment's effects?
Iodine-131 usually is given as a single treatment to produce
remission of Graves' disease. Fatigue, hair loss, and cold intol-
A) "I'll have to isolate myself from my family so I don't expose them
erance are signs of hypothyroidism, which is a complication of the
to radiation."
treatment. Iodine-131 has a quick radioactive decay and half-life;
B) "I'm looking forward to feeling better immediately after this
therefore, isolation is not needed, but it can take up to 2 months
treatment."
for the desired response to develop.
C) "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance."
D) "I'll need to take this drug on a daily basis for at least 1 year."
A nurse is caring for a patient with decreased triiodothyronine
(T3) and thyroxine (T4) and elevated thyroid-stimulating hormone B
(TSH) levels. The nurse knows the patient is likely suffering from The anterior pituitary increases production of TSH when thyroid
what? hormone levels of T3 and T4, are reduced, reflecting primary
hypothyroidism. Patients may experience fatigue caused by a low-
A) Thyrotoxicosis ered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and
B) Hypothyroidism Graves' disease are medical conditions indicative of excessive
C) Hyperthyroidism thyroid activity.
D) Graves' disease
A patient has been given instructions about levothyroxine (Syn-
throid). Which statement by the patient indicates understanding
of these instructions? A
Levothyroxine is used to treat hypothyroidism by increasing the
A) "I'll take this medication in the morning so as not to interfere basal metabolism and thus wakefulness. It is administered as a
with sleep."
B) "I'll plan to double my dose if I gain more than 1 pound per day."
8 / 25
C) "It is best to take the medication with food so I don't have any
nausea." once-daily dose and is a lifelong therapy. It is best taken on an
D) "I'll be glad when I don't have to take this medication in a few empty stomach to enhance absorption.
months."
Which manifestations should a nurse investigate first when mon-
A
itoring a patient who is taking levothyroxine (Synthroid)?
High doses of levothyroxine may cause thyrotoxicosis, a condition
of profound excessive thyroid activity. Tachycardia is the priority
A) Tachycardia
assessment, because it can lead to severe cardiac dysfunction.
B) Tremors
Tremors, insomnia, and irritability are other symptoms of thyro-
C) Insomnia
toxicosis and should be assessed after tachycardia.
D) Irritability
Which finding in a patient taking levothyroxine (Synthroid) and
B
warfarin (Coumadin) would require follow-up by a nurse?
Levothyroxine intensifies the effect of warfarin, an anticoagulant
that increases the patient's risk for bleeding. The warfarin dose
A) Cardiac dysrhythmias
may need to be reduced. Bruising, weight loss, and shortness of
B) Excessive bruising
breath are not effects associated with interactions of levothyroxine
C) Weight loss of 5 kg
and warfarin.
D) Shortness of breath
Which statement is the most important for a nurse to make to a
patient who is taking methimazole?
A
A) "You need to notify your doctor if you have a sore throat and Agranulocytosis (the absence of granulocytes to fight infection) is
fever." the most serious toxicity associated with methimazole. Sore throat
B) "Another medication can be given if you experience any nau- and fever may be the earliest signs. Nausea, muscle soreness,
sea." and headache and dizziness are other adverse effects of methi-
C) "You may experience some muscle soreness with this medi- mazole that are not as serious as agranulocytosis.
cine."
D) "Headache and dizziness may occur but not very frequently."
In the administration of a drug such as levothyroxine (Synthroid),
the nurse should teach the client:
A) That therapy typically lasts about 6 months. C

B) That weekly laboratory tests for T4 levels will be required.
C) To report weight loss, anxiety, insomnia, and palpitations.
D) That the drug may be taken every other day if diarrhea occurs.
A patient with hyperthyroidism is taking propylthiouracil (PTU).
The nurse will monitor the patient for:
A) gingival hyperplasia and lycopenemia. D

B) dyspnea and a dry cough.
C) blurred vision and nystagmus.
D) fever and sore throat.
A physician has prescribed propylthiouracil (PTU) for a client with
hyperthyroidism and the nurse develops a plan of care for the
client. A priority nursing assessment to be included in the plan
regarding this medication is to assess for:
D
a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism
A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg
orally daily, for a client with hypothyroidism. The nurse will prepare
to administer this medication:
A
a) in the morning to prevent insomnia
b) only when the client complains of fatigue and cold intolerance
c) at various times during the day to prevent tolerance from
occurring
9 / 25
d) three times daily in equal doses of 0.5 mg each to ensure
consistent serum drug levels
Myxedema, which includes fatigue, general weakness, and mus-
cle cramps, is a symptom of which endocrine disorder treated with
levothyroxine (Synthroid)?
B
a. Hyperthyroidism
b. Hypothyroidism
c. Cushing's syndrome
d. Addison's disease
Which disease is characterized by increased body metabolism,
tachycardia, increased body temperature, and anxiety, and treat-
ed with Prophylthiouracil (PTU)?
B
a.) Hashimoto's thyroiditis
b.) Graves' disease
c.) Addison's disease
d.) Cushing's syndrome
A client who is taking levothyroxine (Synthroid) begins to develop
weight loss, diarrhea, and intolerance. The nurse should be aware
that this might be an indication of what hormonal condition?
B
a.) Addison's disease
b.) Hyperthyroidism
c.) Cushing's syndrome
d.) Development of acromegaly
Of what precautions should a client receiving radioactive io-
dine-131 be made aware?
a.) Drink plenty of fluids, especially those high in calcium.

b.) Avoid close contact with children or pregnant women for one B
week after administration of drug.
c.) Be aware of the symptoms of tachycardia, increased metabolic
rate, and anxiety.
d.) Wear a mask if around children or pregnant women.
In the administration of a drug such as levothyroxine (Synthroid),
the nurse must teach the client: (Select all that apply.)
a.) Therapy could take three weeks or longer. ABC

b.) Periodic lab tests for T4 levels are required.
c.) Report weight loss, anxiety, insomnia, and palpitations.
d.) Jaundice
A client has been newly diagnosed with hypothyroidism and will
take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of
the teaching plan, the nurse emphasizes that this medication:
A
A) Should be taken in the morning
B) May decrease the client's energy level
C) Must be stored in a dark container
D) Will decrease the client's heart rate
A young woman makes an appointment to see a physician at the
clinic. She complains of tiredness, weight gain, muscle aches and
pains, and constipation. The physician will likely order:
1
These complaints are strongly suggestive of thyroid disorder; T3
1. T3 and T4 serum level laboratory tests.
and T4 laboratory tests are the most useful diagnostic tests.
2. glucose tolerance test.
3. cerebral computed tomography (CT) scan.
4. adrenocortical stimulating test.
10 / 25
The patient asks about his lab test, which showed a high level of
TSH and a low level of T4. You explain:
1. "It means that you have an inconsistency in your thyroid tests,

and you will need more testing."
2. "I am sorry. You will have to ask your doctor about your lab 3
results. We are not allowed to discuss them."
3. "The TSH is sending a message to your thyroid gland to in-
crease production, but your thyroid isn't doing that."
4. "That means that you will have to go on hormone therapy for
the rest of your life."
The nurse instructs the patient is scheduled to have a radioactive
iodine uptake test to:
1. watch for any signs of bleeding or swelling from the biopsy site.
2. avoid contact with others until notified otherwise. 3
3. wash hands with soap and water after each urination for 24
hours after the test.
4. this test demonstrates the effectiveness of the pituitary gland
on the thyroid gland.
The patient, newly diagnosed with hypothyroidism, seems very
anxious to begin her drug regimen. The nurse's instructions in-
clude:
1. "Be certain that no dose is skipped." 3

2. "If a dose is skipped one day, double the dose the next day."
3. "Know the signs and symptoms of hyperthyroidism."
4. "You will be able to notice the benefits of thyroid replacement
therapy right away."
The nurse is caring for a patient who receives levothyroxine.
Which OTC drugs should not be administered within hours of
admin of levythyroxine? Select all that apply.
ABCDE
a. Aluminum hydroxide Do not eat or take anything within hours of levothyroxine. Food
b. Calcium carbonate decreases absorption!
c. Cimetidine
d. Ferrous sulfate
e. Milk of magnesia
Because of the risk of agranulocytosis, the nurse should teach the
patient who has been prescribed PTU to report which symptom?
a. Anorexia D
b. Bleeding gums
c. Pale conjunctiva
d. Sore throat
The client is diagnosed with hypothyroidism. Which signs/symp-
toms would the nurse expect the client to exhibit?
1. Complaints of extreme fatigue and hair loss. 1

2. Exophthalmos and complaints of nervousness.
3. Complaints of profuse sweating and flushed skin.
4. Tetany and complaints of stiffness of the hands.
The nurse identifies the client problem "risk for imbalanced body
temperature" for theclient diagnosed with hypothyroidism. Which
intervention would be included in theclient problem? 2
Decreased metabolism causes the client to be cold frequently;
1. Encourage the use of an electric blanket. therefore, protecting the client from exposure to cold will help
2. Protect from exposure to cold and drafts. increase comfort and decrease further heat loss.
3. Keep the room temperature cool.
4. Space activities to promote rest.
11 / 25
The nurse is teaching the client diagnosed with hyperthyroidism.
Which informationshould be taught to the client? Select all that
apply.
1. Notify the HCP if a three (3)-pound weight loss occurs in two

12345
(2) days.
2. Discuss ways to cope with the emotional lability.
3. Notify the HCP if taking over-the-counter medication.
4. Carry a medical identification card or bracelet.
5. Teach how to take antithyroid medications correctly.
The nurse is completing a health assessment of a 42-year-old
female with suspected Graves' disease. The nurse should assess
this client for:
2
1. anorexia.
2. tachycardia.
3. weight gain.
4. cold skin.
When conducting a health history with a female client with thy-
rotoxicosis, the nurse should ask about which changes in the
menstrual cycle?
3
1. dysmenorrhea
2. metrorrhagia
3. oligomenorrhea
4. menorrhagia
A 34-year-old female is diagnosed with hypothyroidism. What
should the nurse assess the client for? Select all that apply.
1. rapid pulse
2. decreased energy and fatigue 2356
3. weight gain of 10 lb (4.5 kg)
4. fine, thin hair with hair loss
5. constipation
6. menorrhagia
Propylthiouracil (PTU) is prescribed for a client with Graves' dis-
ease. The nurse should teach the client to immediately report:
1. Sore throat. 1
2. painful, excessive menstruation.
3. constipation.
4. increased urine output.
A client with thyrotoxicosis says to the nurse, "I am so irritable.
1 am having problems at work because I lose my temper very
easily." Which response by the nurse would give the client the
most accurate explanation of this behavior?
1. "Your behavior is caused by temporary confusion brought on by

your illness." 2
2. "Your behavior is your caused by the excess thyroid hormone
in your system."
3. "Your behavior is caused by your worrying about the serious-
ness of your illness."
4. "Your behavior is caused by the stress of trying to manage a
career and cope with illness."
The nurse is evaluating a client with hyperthyroidism who is taking
propylthiouracil (PTU) 100 mg/day in three divided doses for
maintenance therapy. Which statement from the client indicates 2
the drug is effective?
12 / 25
1. "I have excess energy throughout the day."
2. "1 am able to sleep and rest at night."
3. "I have lost weight since taking this medication."
4. "I do perspire throughout the entire day."
A client with hyperthyroidism is hospitalized to have a thyroidec-
tomy. The healthcare provider (HCP) has prescribed propranolol.
In reviewing the client's history, the nurse notes that the client has
asthma. The nurse should next:
1. take the client's pulse and withhold the propranolol if the pulse
3
is <100 beats per minute.
2. count the client's respirations and withhold the propranolol if the
respirations are <20 breaths per minute.
3. Contact the HCP and discuss the prescription for propranolol
because of the client's history of having asthma.
4. instruct the client to make position change slowly.
The nurse should teach the client with Graves' disease to prevent
corneal irritation from mild exophthalmos by:
1. massaging the eyes at regular intervals. 3

2. instilling an ophthalmic anesthetic as prescribed.
3. wearing dark-colored glasses.
4. Covering both eyes with moistened gauze pads.
After treatment with radioactive iodine (RAI, 1-131) I, the nurse
should teach the client to:
1. monitor for signs and symptoms of hyperthyroidism.

3
2. rest for 1 week to prevent complications of the medication.
3. take thyroxine replacement for the remainder of the client's life.
4. assess for hypertension and tachycardia resulting from altered
thyroid activity
A client with a large goiter is scheduled for a subtotal thyroidecto-
my to treat thyrotoxicosis. Saturated solution of potassium iodide
(SSKI) is prescribed preoperatively for the client. The expected
outcome of using this drug is that it helps:
2
1.slow progression of exophthalmos
2. reduce the vascularity of the thyroid gland.
3. decrease the body's ability to store thyroxine.
4. increase the body's ability to excrete thyroxine.
The nurse is administering a saturated solution of potassium
iodide (SSKI). The nurse should:
1. pour the solution over ice chips.

3
2. mix the solution with an antacid.
3. dilute the solution with water, milk, or fruit juice and have the
client drink it with a straw.
4. disguise the solution in a pureed fruit or vegetable.
Following a subtotal thyroidectomy, the nurse asks the client
to speak immediately upon regaining consciousness. The nurse
does this to monitor for signs of:
3
1. internal hemorrhage.
2. decreasing level of consciousness.
3. laryngeal nerve damage.
4. upper airway obstruction.
A client who has undergone a subtotal thyroidectomy is subject
to complications in the first 48 hours after surgery. The nurse
should obtain and keep at the bedside equipment to:
13 / 25
1. begin total parenteral nutrition.
2. initiate defibrillation.
4
3. administer tube feedings.
4. perform a tracheotomy.
One day following a subtotal thyroidectomy a client begins to have
tingling in the, fingers and toes. The nurse should first
1. encourage the client to flex and extend the fingers and toes. 2
2. notify the healthcare provider (HCP).
3. assess the client for thrombophlebitis.
4. ask the client to speak.
Which medication should be available to provide emergency
treatment if a client develops tetany after a subtotal thyroidecto-
my?
2
1. Sodium phosphate
2. calcium gluconate
3. echothiophate iodide
4. sodium bicarbonate
A 60-year-old female is diagnosed with hypothyroidism. The nurse
should assess the client for:
1. tachycardia. 2
2. weight gain.
3. diarrhea.
4. nausea.
The nurse should assess a client with hypothyroidism for:
1. corneal abrasion due to inability to close the eyelids.

4
2. weight loss due to hypermetabolism.
3. fluid loss due to diarrhea.
4. decreased activity due to fatigue.
When discussing recent onset of feelings of sadness and depres-
sion in a client with hypothyroidism who has just started to take
thyroid hormone replacement, the nurse should inform the client
that these feelings are:
1. the effects of thyroid hormone replacement therapy and will

4
diminish over time.
2. related to thyroid hormone replacement therapy and will not
diminish over time.
3. a normal part of having a chronic illness.
4. most likely related to low thyroid hormone levels and will im-
prove with treatment.
The nurse is instructing the client with hypothyroidism who takes
levothyroxine 100 mco digoxin, and simvastatin. Teaching regard-
ing the use of these medications is effective if the client will take:
1. the levothyroxine with breakfast and the other medications after

2
breakfast.
2. the levothyroxine before breakfast and the other medications 4
hours later
3. all medications together 1 hour after eating breakfast.
4. all medications before going to bed.
The nurse is teaching a client about maintaining a proper diet
to prevent an endocrine disorder. Which food does the nurse
suggest after the client indicates a dislike of fish?
A
A. Iodized salt for cooking
B. More red meat
14 / 25
C. More green vegetables
D. Salt substitute for cooking
A 33-year-old female client is admitted to the hospital with a
tentative diagnosis of Graves' disease. Which symptom related to
the menstrual cycle would the client be most likely to report during 1
the initial assessment? Amenorrhea or a decreased menstrual flow occurs in the client
with Graves' disease. Menorrhagia, metrorrhagia, and dysmenor-
1. Amenorrhea rhea are also disorders related to the female reproductive system;
2. Menorrhagia however, they are not typical manifestations of Graves' disease.
3. Metrorrhagia
4. Dysmenorrhea
The nurse is monitoring a client for signs of hypocalcemia after
3
thyroidectomy. Which sign or symptom, if noted in the client, would
After thyroidectomy the nurse assesses the client for signs of
most likely indicate the presence of hypocalcemia?
hypocalcemia and tetany. Early signs include tingling around the
mouth and in the fingertips, muscle twitching or spasms, pal-
1. Bradycardia
pitations or arrhythmias, and Chvostek's and Trousseau's signs.
2. Flaccid paralysis
Bradycardia, flaccid paralysis, and absence of Chvostek's sign are
3. Tingling around the mouth
not signs of hypocalcemia.
4. Absence of Chvostek's sign
The nurse is performing an assessment on a client with a diag- 2
nosis of hyperthyroidism. Which assessment finding should the Hyperthyroidism is clinically manifested by goiter (increase in the
nurse expect to note in this client? size of the thyroid gland) and exophthalmos (bulging eyeballs).
Other clinical manifestations include nervousness, fatigue, weight
1. Dry skin loss, muscle cramps, and heat intolerance. Additional signs found
2. Bulging eyeballs in this disorder include tachycardia; shortness of breath; exces-
3. Periorbital edema sive sweating; fine muscle tremors; thin, silky hair and thin skin;
4. Coarse facial features infrequent blinking; and a staring appearance.
The nurse has developed a postoperative plan of care for a client 2
who had a thyroidectomy and documents that the client is at After thyroidectomy, neck circumference is monitored every 4
risk for developing an ineffective breathing pattern. Which nursing hours to assess for the occurrence of postoperative edema. The
intervention should the nurse include in the plan of care? client should be placed in an upright position to facilitate air
exchange. A pressure dressing is not placed on the operative site
1. Maintain a supine position. because it may restrict breathing. The nurse should monitor the
2. Monitor neck circumference every 4 hours. dressing closely and should loosen the dressing if necessary. The
3. Maintain a pressure dressing on the operative site. nurse should assist the client with deep-breathing exercises, but
4. Encourage deep-breathing exercises and vigorous coughing coughing is minimized to prevent tissue damage and stress to the
exercises. incision.
A client has returned to the nursing unit after a thyroidectomy. The
nurse notes that the client is complaining of tingling sensations
2
around the mouth, fingers, and toes. On the basis of these find-
After surgery on the thyroid gland, the client may experience
ings, the nurse should next assess the results of which serum
a temporary calcium imbalance. This is due to transient mal-
laboratory study?
function of the parathyroid glands. The nurse also would assess
for Chvostek's and Trousseau's signs. The correct treatment is
1. Sodium
administration of calcium gluconate or calcium lactate. The re-
2. Calcium
maining options are unrelated to the client's complaints.
3. Potassium
4. Magnesium
2
A client is admitted to an emergency department, and a diagnosis Myxedema coma is a rare but serious disorder that results from
of myxedema coma is made. Which action should the nurse persistently low thyroid production. Coma can be precipitated by
prepare to carry out initially? acute illness, rapid withdrawal of thyroid medication, anesthesia
and surgery, hypothermia, and the use of sedatives and opioid
1. Warm the client. analgesics. In myxedema coma, the initial nursing action is to
2. Maintain a patent airway. maintain a patent airway. Oxygen should be administered, fol-
3. Administer thyroid hormone. lowed by fluid replacement, keeping the client warm, monitoring
4. Administer fluid replacement. vital signs, and administering thyroid hormones by the intravenous
route.
A client with medullary carcinoma of the thyroid has an excess
function of the C cells of the thyroid gland. When reviewing the
most recent laboratory results, the nurse should expect which
15 / 25
electrolyte abnormality?
2
1. Sodium The C cells of the thyroid gland are helpful in maintaining normal
2. Calcium plasma calcium levels. They do not affect the levels of sodium,
3. Potassium potassium, or magnesium.
4. Magnesium
A client visits the health care provider's office for a routine physical
examination and reports a new onset of intolerance to cold. Since
hypothyroidism is suspected, which additional information would 2
be noted during the client's assessment? Weakness and lethargy are the most common complaints asso-
ciated with hypothyroidism. Other common symptoms include in-
1. Weight loss and tachycardia tolerance to cold, weight gain, bradycardia, decreased respiratory
2. Complaints of weakness and lethargy rate, dry skin, and hair loss.
3. Diaphoresis and increased hair growth
4. Increased heart rate and respiratory rate
34
The clinical manifestations of hyperthyroidism are the result of
The nurse should include which interventions in the plan of care
increased metabolism caused by high levels of thyroid hormone.
for a client with hyperthyroidism? (SATA)
Interventions are aimed at reduction of the hormones and mea-
sures to support the signs and symptoms related to an increased
1. Provide a warm environment for the client.
metabolism. The client often has heat intolerance and requires a
2. Instruct the client to consume a low-fat diet.
cool environment. The nurse encourages the client to consume a
3. A thyroid-releasing inhibitor will be prescribed.
well-balanced diet because clients with this condition experience
4. Encourage the client to consume a well-balanced diet.
increased appetite. Iodine preparations are used to treat hyper-
5. Instruct the client that thyroid replacement therapy will be
thyroidism. Iodine preparations decrease blood flow through the
needed.
thyroid gland and reduce the production and release of thyroid
6. Instruct the client that episodes of chest pain are expected to
hormone. Thyroid replacement is needed for hypothyroidism. The
occur.
client would notify the health care provider if chest pain occurs
because it could be an indication of an excessive medication dose.
13
The nurse is completing an assessment on a client who is being
The role of parathyroid hormone (PTH) in the body is to maintain
admitted for a diagnostic workup for primary hyperparathyroidism.
serum calcium homeostasis. In hyperparathyroidism, PTH levels
Which client complaint would be characteristic of this disorder?
are high, which causes bone resorption (calcium is pulled from
Select all that apply.
the bones). Hypercalcemia occurs with hyperparathyroidism. El-
evated serum calcium levels produce osmotic diuresis and thus
1. Polyuria
polyuria. This diuresis leads to dehydration (weight loss rather
2. Headache
than weight gain). Loss of calcium from the bones causes bone
3. Bone pain
pain. Options 2, 4, and 5 are not associated with hyperparathy-
4. Nervousness
roidism. Some gastrointestinal symptoms include anorexia, nau-
5. Weight gain
sea, vomiting, and constipation.
A client has abnormal amounts of circulating thyronine (T3) and
thyroxine (T4). While obtaining the health history, the nurse asks
1
the client about dietary intake. Lack of which dietary element is
Adequate dietary iodine is needed to produce T3 and T4. The
most likely the cause?
other requirements for adequate T3 and T4 production are an in-
tact thyroid gland and a functional hypothalamus-pituitary-thyroid
1. Iodine
feedback system. The remaining options are not responsible for
2. Calcium
the abnormal amounts of circulating T3 and T4.
3. Phosphorus
4. Magnesium
A nurse is caring for a client with a dysfunctional thyroid gland
and is concerned that the client will exhibit a sign of thyroid storm.
3
Which is an early indicator of this complication?
Clinical manifestations of thyroid storm include a fever as high as
106°F, hyperreflexia, abdominal pain, diarrhea, dehydration rapid-
1. Bradycardia
ly progressing to coma, severe tachycardia, extreme vasodilation,
2. Constipation
hypotension, atrial fibrillation, and cardiovascular collapse.
3. Hyperreflexia
4. Low-grade temperature
A client has begun medication therapy with propylthiouracil. The 4
nurse should assess the client for which condition as an adverse Propylthiouracil is prescribed for the treatment of hyperthyroidism.
effect of this medication? Excessive dosing with this agent may convert a hyperthyroid
16 / 25
state to a hypothyroid state. If this occurs, the dosage should
1. Joint pain be reduced. Temporary administration of thyroid hormone may
2. Renal toxicity be required to treat the hypothyroid state. Propylthiouracil is not
3. Hyperglycemia used for relief of joint pain. It does not cause renal toxicity or
4. Hypothyroidism hyperglycemia.
The client diagnosed with hypothyroidism is prescribed the thy-
roid hormone levothyroxine (Synthroid). Which assessment data
indicate the medication has been effective?
3
1. The client has a three (3)-pound weight gain.
2. The client has a decreased pulse rate.
3. The client's temperature is WNL.
4. The client denies any diaphoresis.
Which nursing intervention should be included in the plan of care
for the client diagnosed with hyperthyroidism?
1. Increase the amount of fiber in the diet. 4

2. Encourage a low-calorie, low-protein diet.
3. Decrease the client's fluid intake to 1,000 mL/day.
4. Provide six (6) small, w
The client diagnosed with hyperthyroidism is complaining of being
hot and cannot sit still. Which should the nurse do based on the
assessment?
1
1. Continue to monitor the client.
2. Have the UAP take the client's vital signs.
3. Request an order for a sedative.
4. Insist the client lie down and rest.
The client is diagnosed with hypothyroidism. Which assessment
data support this diagnosis?
1. The client's vital signs are: T 99.0, P 110, R 26, and BP 145.80. 2
2. The client complains of constipation and being constantly cold.
3. The client has an intake of 780 mL and output of 256 mL.
4. The client complains of a headache and has projectile vomiting.
Which sign/symptom indicates to the nurse the client is experi-
encing hypoparathyroidism?
1. A negative Trousseau's sign. 2

2. A positive Chvostek's sign.
3. Nocturnal muscle cramps.
4. Tented skin turgor.
Which laboratory data make the nurse suspect the client with
primary hyperparathyroidism is experiencing a complication?
1. A serum creatinine level of 2.8 mg/dL. 1

2. A calcium level of 9.2 mg/dL.
3. A serum triglyceride level of 130 mg/dL.
4. A sodium level of 135 mEq/L.
Which signs/symptoms indicate the client with hypothyroidism is
not taking enough thyroid hormone?
1. Complaints of weight loss and fine tremors. 3

2. Complaints of excessive thirst and urination.
3. Complaints of constipation and being cold.
4. Complaints of delayed wound healing and belching.
Secretes three hormones essential for proper regulation of me-
tabolism: thyroxine (T„), triiodothyronine (Tƒ), calcitonin A
17 / 25
A. Thyroid Gland
B. Parathyroid gland
Is responsible for maintaining adequate levels of calcium in the
extracellular fluid
B
A. Thyroid Gland
B. Parathyroid gland
Common signs and symptoms of hypo-thyroidism:
A. Bloody stool and vomiting

B
B. Thickened skin, hair loss, constipation, lethargy, and anorexia
C. Fever, weight gain, high energy
D. Jaudice, thin skin, and random hair growth
Goiter, a type of hypo-thyroidism, includes:
A. Enlargement of the thyroid gland

B. Results from over stimulation by elevated levels of TSH D
C. TSH is elevated because there is little or no thyroid hormone
in circulation
D. All of the above
Thyroid drugs for hypo-thyroidism:
A. Levothyroxine, Liothyronine, Liotrix, Thyroid A

B. Methimazole (Tapazole), Propylthiouracil (PTU)
C. All of the above
Synthetic thyroid hormone T„ (most common):
A. Levothyroxine
A
B. Liothyronine
C. Liotrix
D. Thyroid
Synthetic thyroid hormone Tƒ:
A. Levothyroxine
B
B. Liothyronine
C. Liotrix
D. Thyroid
Synthetic thyroid hormone Tƒ-T4„ combined:
A. Levothyroxine
C
B. Liothyronine
C. Liotrix
D. Thyroid
Indications for:Levothyroxine, Liothyronine. Liotrix, Thyroid (SATA)
A. Used to treat all three forms of hypo-thyroidism.

B. Used to treat hyper-thyroidism and to prevent the surge in thy-
roid hormones that occurs after the surgical treatment or during AC
radioactive iodine treatment for hyperthyroidism
C. Used for thyroid replacement in patients whose thyroid glands
have been surgically removed or destroyed by radioactive iodine
in the treatment of thyroid cancer or hyperthyroidism
Anti-thyroid drugs for hyper-thyroidism:
A. Levothyroxine, Liothyronine, Liotrix, Thyroid B

B. Methimazole (Tapazole), Propylthiouracil (PTU)
C. All of the above
Indications for:Methimazole (Tapazole)Propylthiouracil (PTU)
18 / 25
A. Used to treat all three forms of hypo-thyroidism.
B. Used to treat hyper-thyroidism and to prevent the surge in thy-
roid hormones that occurs after the surgical treatment or during
radioactive iodine treatment for hyperthyroidism B
C. Used for thyroid replacement in patients whose thyroid glands
have been surgically removed or destroyed by radioactive iodine
in the treatment of thyroid cancer or hyperthyroidism
Adverse effects for:Methimazole (Tapazole)Propylthiouracil
(PTU)
A. Cardiac dysrhythmia
B. Liver and bone marrow toxicity; joint pain B
C. May also cause: tachycardia, palpitations, angina, hyperten-
sion, insomnia, tremors, headache, anxiety, nausea, diarrhea,
menstrual irregularities, weight loss, appetite changes, sweating,
heat intolerance
Treatment of hyper-thyroidism includes:
A. Radioactive iodine (I¹³³) works by destroying the thyroid gland

D
B. Surgery to remove all or part of the thyroidgland
C. Lifelong thyroid hormone replacement maybe needed
D. All of the above
Which statement by the patient indicates an understanding of dis-
charge instructions given by the nurse about the newly prescribed
medication levothyroxine (Synthroid)?
A. "I will take a double dose to make up for the missed one."
D
B. "I can expect improvement of my symptoms within 1 week."
C. "I will stop the medication immediately if I feel pain or weakness
in my muscles."
D. "I will take this medication in the morning so it does not affect
my sleep at night."
The nurse would suspect a patient is taking too much levothyrox-
ine (Synthroid) when the patient exhibits which adverse effect?
A. Lethargy B
B. Irritability
C. Feeling cold
D. Weight gain
A patient receiving propylthiouracil (PTU) asks the nurse, "How
does this medication relieve symptoms?" What is the nurse's best
response?
A. "PTU helps your thyroid gland synthesize and use iodine, which
produces hormones better."
B. "PTU inhibits the formation of new thyroid hormone, thus re-
B
turning your metabolism to normal."
C. "PTU causes the pituitary gland to secrete thyroid-stimulating
hormone, which blocks the production of hormones by the thyroid
gland."
D. "PTU removes thyroid hormones that are already circulating
in your bloodstream, thus decreasing the adverse effects of this
medication."
The nurse is teaching a patient taking an antithyroid medication to
avoid food items high in iodine. Which food item should the nurse
instruct the patient to avoid?
D
A. Milk
B. Eggs
19 / 25
C. Chicken
D. Seafood
Which patient statement demonstrates understanding of radioac-
tive iodine (I-131) therapy?
A. "I will need to take this drug on a daily basis for at least 1 year."
B. "This drug will help decrease my cold intolerance and weight
C
gain."
C. "This drug will be taken up by the thyroid gland and destroy
thyroid tissue."
D. "I will isolate myself from my family for 1 week so there is no
risk of radiation exposure."
When assessing for potential serious adverse effects to propylth-
iouracil (PTU), the nurse will monitor which laboratory test?
A. Kidney function C
B. Serum electrolytes
C. Complete blood count (CBC)
D. Brain natriuretic peptide
The nurse is reviewing the adverse effects of antithyroid med-
ications for a patient prescribed propylthiouracil (PTU). What po-
tential serious adverse effects should the nurse discuss with the
patient during discharge teaching? (Select all that apply.)
ABE
A. Joint pain
B. Liver toxicity
C. Kidney damage
D. Increased urination
E. Bone marrow toxicity
The nurse explains to a client with thyroid disease that the thyroid
gland normally produces: 4
The thyroid gland normally produces thyroid hormone (T3 and T4)
1. iodine and thyroid-stimulating hormone (TSH). and calcitonin. TSH is produced by the pituitary gland to regulate
2. thyrotropin-releasing hormone (TRH) and TSH. the thyroid gland. TRH is produced by the hypothalamus gland to
3. TSH, T3, and calcitonin. regulate the pituitary gland.
4. T3, T4, and calcitonin.
A client is seen in the clinic with a possible parathormone defi-
ciency. Diagnosis of this condition includes the analysis of serum
electrolytes. Which electrolytes would the nurse expect to be
abnormal? (SATA) 36
A client with a parathormone deficiency has abnormal calcium
1. Sodium and phosphorous values because parathormone regulates these
2. Potassium two electrolytes. Potassium, chloride, sodium, and glucose aren't
3. Calcium affected by a parathormone deficiency.
4. Chloride
5. Glucose
6. Phosphorous
A client is being returned to the room after a subtotal thyroidecto- 2
my. Which piece of equipment is most important for the nurse to After a subtotal thyroidectomy, swelling of the surgical site (the tra-
keep at the client's bedside? cheal area) may obstruct the airway. Therefore, the nurse should
keep a tracheostomy set at the client's bedside in case of a respi-
1. Indwelling urinary catheter kit ratory emergency. Although an indwelling urinary catheter and a
2. Tracheostomy set cardiac monitor may be used for a client after a thyroidectomy, the
3. Cardiac monitor tracheostomy set is more important. A humidifier isn't indicated for
4. Humidifier this client.
Which nursing diagnosis takes highest priority for a client with 4
hyperthyroidism? In the client with hyperthyroidism, excessive thyroid hormone pro-
duction leads to hypermetabolism and increased nutrient metab-
1. Risk for imbalanced nutrition: More than body requirements olism. These conditions may result in a negative nitrogen balance,
related to thyroid hormone excess increased protein synthesis and breakdown, decreased glucose
20 / 25
2. Risk for impaired skin integrity related to edema, skin fragility, tolerance, and fat mobilization and depletion. This puts the client at
and poor wound healing risk for marked nutrient and calorie deficiency, making Imbalanced
3. Disturbed body image related to weight gain and edema nutrition: Less than body requirements the most important nursing
4. Imbalanced nutrition: Less than body requirements related to diagnosis. Options 2 and 3 may be appropriate for a client with
thyroid hormone excess hypothyroidism, which slows the metabolic rate.
Which important instruction concerning the administration of
levothyroxine (Synthroid) should the nurse teach a client?
1
The nurse should instruct the client to take levothyroxine on an
1. "Take the drug on an empty stomach."
empty stomach (to promote regular absorption) in the morning (to
2. "Take the drug with meals."
help prevent insomnia and to mimic normal hormone release).
3. "Take the drug in the evening."
4. "Take the drug whenever convenient."
During preoperative teaching for a client who will undergo subtotal
4
thyroidectomy, the nurse should include which statement?
To prevent undue pressure on the surgical incision after subtotal
thyroidectomy, the nurse should advise the client to avoid hyper-
1. "The head of your bed must remain flat for 24 hours after
extending the neck. The client may elevate the head of the bed
surgery."
as desired and should perform deep breathing and coughing to
2. "You should avoid deep breathing and coughing after surgery."
help prevent pneumonia. Subtotal thyroidectomy doesn't affect
3. "You won't be able to swallow for the first day or two."
swallowing.
4. "You must avoid hyperextending your neck after surgery."
The nurse is assessing a client with hyperthyroidism. What find-
2
ings should the nurse expect?
Weight loss, nervousness, and tachycardia are signs of hyper-
thyroidism. Other signs of hyperthyroidism include exophthal-
1. Weight gain, constipation, and lethargy
mos, diaphoresis, fever, and diarrhea. Weight gain, constipation,
2. Weight loss, nervousness, and tachycardia
lethargy, decreased sweating, and cold intolerance are signs of
3. Exophthalmos, diarrhea, and cold intolerance
hypothyroidism.
4. Diaphoresis, fever, and decreased sweating
A client visits the physician's office complaining of agitation,
restlessness, and weight loss. The physical examination reveals
exophthalmos, a classic sign of Graves' disease. Based on his- 2
tory and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by protruding eyes and a fixed
Exophthalmos is characterized by: stare. Dry, waxy swelling and abnormal mucin deposits in the
skin typify myxedema, a condition resulting from advanced hy-
1. dry, waxy swelling and abnormal mucin deposits in the skin. pothyroidism. A wide, staggering gait and a differential between
2. protruding eyes and a fixed stare. the apical and radial pulse rates aren't specific signs of thyroid
3. a wide, staggering gait. dysfunction.
4. more than 10 beats/minute difference between the apical and
radial pulse rates.
An incoherent client with a history of hypothyroidism is brought
to the emergency department by the rescue squad. Physical and
3
laboratory findings reveal hypothermia, hypoventilation, respira-
Severe hypothyroidism may result in myxedema coma, in which a
tory acidosis, bradycardia, hypotension, and nonpitting edema of
drastic drop in the metabolic rate causes decreased vital signs,
the face and pretibial area. Knowing that these findings suggest
hypoventilation (possibly leading to respiratory acidosis), and
severe hypothyroidism, the nurse prepares to take emergency
nonpitting edema. Thyroid storm is an acute complication of hy-
action to prevent the potential complication of:
perthyroidism. Cretinism is a form of hypothyroidism that occurs in
infants. Hashimoto's thyroiditis is a common chronic inflammatory
1. thyroid storm.
disease of the thyroid gland in which autoimmune factors play a
2. cretinism.
prominent role.
3. myxedema coma.
4. Hashimoto's thyroiditis.
3
When caring for a client who's being treated for hyperthyroidism, A client with hyperthyroidism needs to be encouraged to balance
it's important to: periods of activity and rest. Many clients with hyperthyroidism are
hyperactive and complain of feeling very warm. Consequently,
1. provide extra blankets and clothing to keep the client warm. it's important to keep the environment cool and to teach the
2. monitor the client for signs of restlessness, sweating, and client how to manage his physical reactions to heat. Clients with
excessive weight loss during thyroid replacement therapy. hypothyroidism — not hyperthyroidism — complain of being cold
3. balance the client's periods of activity and rest. and need warm clothing and blankets to maintain a comfortable
4. encourage the client to be active to prevent constipation. temperature. They also receive thyroid replacement therapy, often
feel lethargic and sluggish, and are prone to constipation. The
21 / 25
nurse should encourage clients with hypothyroidism to be more
active to prevent constipation.
Before undergoing a subtotal thyroidectomy, a client receives 4
potassium iodide (Lugol's solution) and propylthiouracil (PTU). Potassium iodide reduces the vascularity of the thyroid gland and
The nurse would expect the client's symptoms to subside: is used to prepare the gland for surgery. Potassium iodide reaches
its maximum effect in 1 to 2 weeks. PTU blocks the conversion of
1. in a few days. thyroxine to triiodothyronine, the more biologically active thyroid
2. in 3 to 4 months. hormone. PTU effects are also seen in 1 to 2 weeks. To relieve
3. immediately. symptoms of hyperthyroidism in the interim, clients are usually
4. in 1 to 2 weeks. given a beta-adrenergic blocker such as propranolol.
A client is being treated for hypothyroidism. The nurse knows
that thyroid replacement therapy has been inadequate when she 135
notes which findings? (SATA) In hypothyroidism, the body is in a hypometabolic state. Therefore,
a prolonged QT interval with bradycardia and subnormal body
1. Prolonged QT interval on electrocardiogram temperature would indicate that replacement therapy was inad-
2. Tachycardia equate. Tachycardia, nervousness, and dry mouth are symptoms
3. Low body temperature of an excessive level of thyroid hormone; these findings would
4. Nervousness indicate that the client has received an excessive dose of thyroid
5. Bradycardia hormone.
6. Dry mouth
2
A businesswoman comes into the clinic with a progressively en-
A goiter can result from inadequate dietary intake of iodine asso-
larging neck. The client mentions that she has been in a foreign
ciated with changes in foods or malnutrition. It's caused by insuf-
country for the previous 3 months and that she didn't eat much
ficient thyroid gland production and depletion of glandular iodine.
while she was there because she didn't like the food. The client
Signs and symptoms of this malfunction include enlargement of
also mentions that she becomes dizzy when lifting her arms to
the thyroid gland, dizziness when raising the arms above the
do normal household chores or when dressing. What endocrine
head, dysphagia, and respiratory distress. Signs and symptoms
disorder would the nurse expect the physician to diagnose?
of diabetes mellitus include polydipsia, polyuria, and polypha-
gia. Signs and symptoms of diabetes insipidus include extreme
1. Diabetes mellitus
polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue
2. Goiter
turgor, dry mucous membranes, constipation, dizziness, and hy-
3. Diabetes insipidus
potension). Cushing's syndrome causes buffalo hump, moon face,
4. Cushing's syndrome
irritability, emotional lability, and pathologic fractures.
Early this morning, a client had a subtotal thyroidectomy. During
2
evening rounds, the nurse assesses the client, who now has nau-
Thyroid crisis usually occurs in the first 12 hours after thyroidec-
sea, a temperature of 105° F (40.5° C), tachycardia, and extreme
tomy and causes exaggerated signs of hyperthyroidism, such
restlessness. What is the most likely cause of these signs?
as high fever, tachycardia, and extreme restlessness. Diabetic
ketoacidosis is more likely to produce polyuria, polydipsia, and
1. Diabetic ketoacidosis
polyphagia; hypoglycemia, to produce weakness, tremors, pro-
2. Thyroid crisis
fuse perspiration, and hunger. Tetany typically causes uncontrol-
3. Hypoglycemia
lable muscle spasms, stridor, cyanosis, and possibly asphyxia.
4. Tetany
A 56-year-old female client is being discharged after undergoing a
thyroidectomy. Which discharge instructions would be appropriate
for this client?
1. "Report signs and symptoms of hypoglycemia."

2. "Take thyroid replacement medication as ordered." 23
3. "Watch for changes in body functioning, such as lethargy,
restlessness, sensitivity to cold, and dry skin, and report these
changes to the physician."
4. "Recognize the signs of dehydration."
5. "Carry injectable dexamethasone at all times."
4
For a client with Graves' disease, which nursing intervention pro- Graves' disease causes signs and symptoms of hypermetabolism,
motes comfort? such as heat intolerance, diaphoresis, excessive thirst and ap-
petite, and weight loss. To reduce heat intolerance and diaphore-
1. Restricting intake of oral fluids sis, the nurse should keep the client's room temperature in the
2. Placing extra blankets on the client's bed low-normal range. To replace fluids lost via diaphoresis, the nurse
should encourage, not restrict, intake of oral fluids. Placing extra
22 / 25
blankets on the bed of a client with heat intolerance would cause
3. Limiting intake of high-carbohydrate foods
discomfort. To provide needed energy and calories, the nurse
4. Maintaining room temperature in the low-normal range
should encourage the client to eat high-carbohydrate foods
A client with hyperthyroidism is about to receive radioactive iodine 3
as an outpatient. What safety measures should the nurse teach The client with hyperthyroidism can receive radioactive iodine
the client to protect his family while he undergoes treatment? as an outpatient with some precautions, such as using dispos-
able eating utensils, and avoiding kissing, sexual intercourse,
1. Good hand washing and holding babies. Good hand washing is always necessary to
2. How to isolate himself in one room of the house prevent the spread of infection; however, it provides no protection
3. Use of disposable eating utensils against radioactive iodine therapy. Isolation isn't necessary, but
4. Not worrying about precautions radiation precautions are
A client receiving thyroid replacement therapy develops the flu
3
and forgets to take her thyroid replacement medicine. The nurse
Myxedema coma, severe hypothyroidism, is a life-threatening
understands that skipping this medication will put the client at risk
condition that may develop if thyroid replacement medication isn't
for developing which life-threatening complication?
taken. Exophthalmos, protrusion of the eyeballs, is seen with
hyperthyroidism. Thyroid storm is life-threatening but is caused
1. Exophthalmos
by severe hyperthyroidism. Tibial myxedema, peripheral mucinous
2. Thyroid storm
edema involving the lower leg, is associated with hypothyroidism
3. Myxedema coma
but isn't life-threatening.
4. Tibial myxedema
The physician orders laboratory tests to confirm hyperthyroidism
in a client with classic signs and symptoms of this disorder. Which
1
test result would confirm the diagnosis?
In the TSH test, failure of the TSH level to rise after 30 minutes
confirms hyperthyroidism. A decreased TSH level indicates a pi-
1. No increase in the thyroid-stimulating hormone (TSH) level after
tuitary deficiency of this hormone. Below-normal levels of T3 and
30 minutes during the TSH stimulation test
T4, as detected by radioimmunoassay, signal hypothyroidism. A
2. A decreased TSH level
below-normal T4 level also occurs in malnutrition and liver disease
3. An increase in the TSH level after 30 minutes during the TSH
and may result from administration of phenytoin and certain other
stimulation test
drugs.
4. Below-normal levels of serum triiodothyronine (T3) and serum
thyroxine (T4) as detected by radioimmunoassay
The nurse should expect a client with hypothyroidism to report
which health concern(s)? 2
Hypothyroidism (myxedema) causes facial puffiness, extremity
1. Increased appetite and weight loss edema, and weight gain. Signs and symptoms of hyperthyroidism
2. Puffiness of the face and hands (Graves' disease) include an increased appetite, weight loss, ner-
3. Nervousness and tremors vousness, tremors, and thyroid gland enlargement (goiter).
4. Thyroid gland swelling
A client with hypothyroidism (myxedema) is receiving levothyrox-
ine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse
3
recognize as an adverse reaction to the drug?
Levothyroxine, a synthetic thyroid hormone, is given to a client
with hypothyroidism to simulate the effects of thyroxine. Adverse
1. Dysuria
reactions to this agent include tachycardia. The other options
2. Leg cramps
aren't associated with levothyroxine.
3. Tachycardia
4. Blurred vision
The nurse is caring for a patient who has hypothyroidism. To assist
in differentiating between primary and secondary hypothyroidism, D
the nurse will expect the provider to order which drug? Thyrotropin is a purified extract of thyroid-stimulating hormone
and is used as a diagnostic agent todifferentiate between primary
a. Liothyronine sodium (Cytomel) and secondary hypothyroidism. Liothyronine and liotrix are thyroid
b. Liotrix (Thyrolar) replacementdrugs. Methimazole is used to decrease thyroid hor-
c. Methimazole (Tapazole) mone secretion
d. Thyrotropin (Thytropar)
A patient who takes warfarin (Coumadin) and digoxin (Lanox-
in) develops hypothyroidism and will begin taking levothyroxine
C
(Synthroid). The nurse anticipates which potential adjustments in
Thyroid preparations increase the effect of oral anticoagulants, so
dosing for this patient?
the warfarin dose may need to be decreased. Levothyroxine can
a. Decreased digoxin and decreased warfarin
23 / 25
b. Decreased digoxin and increased warfarin
decrease the effectiveness of digoxin, so this dose may need to
c. Increased digoxin and decreased warfarin
be increased.
d. Increased digoxin and increased warfarin
A patient who takes the oral antidiabetic agent metformin (Glu-
cophage) will begin taking levothyroxine (Synthroid). The nurse
will teach this patient to monitor for A
Insulin and oral antidiabetic drugs may need to be increased in
a. hyperglycemia. patients taking levothyroxine. Patients shouldbe taught to monitor
b. hypoglycemia. for hyperglycemia, because of the reduced effects of these drugs.
c. hyperkalemia.
d. hypokalemia.
A patient with Graves disease exhibits tachycardia, heat intoler-
ance, and exophthalmos. Prior to surgery, which drug is used to
C
alter thyroid hormone levels?
Propylthiouracil is a potent antithyroid drug used in preparation for
a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid
a. Liotrix (Thyrolar)
replacement. Propranolol is used to treat hypertension associated
b. Propranolol (Inderal)
with hyperthyroidism
c. Propylthiouracil (PTU)
d. Thyroid (Thyrotab)
A nurse prepares to palpate a client's thyroid gland. Which action
D
should the nurse take when performing this assessment?
The client should be in a sitting position with the chin tucked down
as the examiner stands behind the client. The nurse feels for the
a. Stand in front of the client instead of behind the client.
thyroid isthmus while the client swallows and turns the head to
b. Ask the client to swallow after palpating the thyroid.
the right, and the nurse palpates the right lobe with the right hand.
c. Palpate the right lobe with the nurses left hand.
The technique is repeated in the opposite fashion for the left lobe.
d. Place the client in a sitting position with the chin tucked down
Which complication should the nurse assess for in the elderly
client newly diagnosed with hypothyroidism who has been pre-
scribed levothyroxine?
1
1. Cardiac dysrhythmias.
2. Respiratory depression.
3. Paralytic ileus.
4. Thyroid storm.
The client diagnosed with hyperthyroidism is prescribed propylth-
4
iouracil. Which laboratory data should the nurse monitor?
The client receiving PTU, a hyperthyroid treatment, is at risk
for agranulocytosis; therefore, the client's WBC count should be
1. The client's arterial blood gases (ABGs).
checked periodically. Because agranulocytosis puts the client at
2. The client's serum potassium level.
greater risk for infection, efforts to control invasion of microbes
3. The client's red blood cell (RBC) count.
should be strictly observed.
4. The client's white blood cell (WBC) count.
The client diagnosed with hyperthyroidism is prescribed propylth-
iouracil (PTU). Which statement by the client warrants immediate 2
intervention by the nurse? Propylthiouracil (PTU) is a hyperthyroid treatment. The antithyroid
medication may affect the body's ability to defend itself against
1. "I seem to be drowsy and sleepy all the time." bacteria and viruses; therefore, the nurse should intervene if the
2. "I have a sore throat and have had a fever." client has any type of sore throat, fever, chills, malaise, or weak-
3. "I have gained 2 pounds since I started taking PTU." ness.
4. "Since taking PTU I am not as hot as I used to be."
The client diagnosed with hyperthyroidism is prescribed an an- 12345
tithyroid medication. Which interventions should the nurse imple- Thyroid function tests are used to determine the effectiveness of
ment? Select all that apply. drug therapy. Weight gain is expected as a result of a slower me-
tabolism. Antithyroid medication may cause nausea or vomiting.
1. Monitor the client's thyroid function tests. Changes in metabolic rate will be manifested as changes in blood
2. Monitor the client's weight weekly. pressure, pulse, and body temperature. Hyperthyroidism results in
3. Monitor the client for gastrointestinal distress. protein catabolism, overactivity, and increased metabolism, which
4. Monitor the client's vital signs. lead to exhaustion; therefore, the nurse should monitor for activity
5. Monitor the client for activity intolerance. intolerance.
24 / 25
A patient receiving propylthiouracil (PTU) asks the nurse how this
medication will help relieve his symptoms. What is the nurse's best
response?
1. "Propylthiouracil inactivates any circulating thyroid hormone,

thus decreasing signs and symptoms of hyperthyroidism."
2. "Propylthiouracil inhibits the formation of new thyroid hormone, 2
thus gradually returning your metabolism to normal."
3. "Propylthiouracil helps your thyroid gland use iodine and syn-
thesize hormones better."
4. "Propylthiouracil stimulates the pituitary gland to secrete thy-
roid-stimulating hormone (TSH), which inhibits the production of
hormones by the thyroid gland."
The nurse would suspect excessive thyroid replacement in a pa-
tient taking levothyroxine (Synthroid) when the patient is exhibiting
which adverse effect?
4
1. Depression
2. Intolerance to cold
3. Weight gain
4. Irritability
25 / 25

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Exam 4: Thyroid Disorder (NCLEX)

Study online at https://quizlet.com/_8yuqix

1. Complaints of extreme fatigue and hair loss. 1

1. Explain it will take up to a month for symptoms of hyperthy-

A) That therapy typically lasts about 6 months. C

A) gingival hyperplasia and lycopenemia. D

a.) Drink plenty of fluids, especially those high in calcium.

a.) Therapy could take three weeks or longer. ABC

1. "It means that you have an inconsistency in your thyroid tests,

1. "Be certain that no dose is skipped." 3

1. Complaints of extreme fatigue and hair loss. 1

1. Notify the HCP if a three (3)-pound weight loss occurs in two

1. "Your behavior is caused by temporary confusion brought on by

1. massaging the eyes at regular intervals. 3

1. monitor for signs and symptoms of hyperthyroidism.

1. pour the solution over ice chips.

1. corneal abrasion due to inability to close the eyelids.

1. the effects of thyroid hormone replacement therapy and will

1. the levothyroxine with breakfast and the other medications after

1. Increase the amount of fiber in the diet. 4

1. A negative Trousseau's sign. 2

1. A serum creatinine level of 2.8 mg/dL. 1

1. Complaints of weight loss and fine tremors. 3

A. Bloody stool and vomiting

A. Enlargement of the thyroid gland

A. Levothyroxine, Liothyronine, Liotrix, Thyroid A

A. Used to treat all three forms of hypo-thyroidism.

A. Levothyroxine, Liothyronine, Liotrix, Thyroid B

A. Radioactive iodine (I¹³³) works by destroying the thyroid gland

1. "Report signs and symptoms of hypoglycemia."

1. "Propylthiouracil inactivates any circulating thyroid hormone,

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