Chapter 43: Management of Clients with Thyroid and Parathyroid Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 43: Management of Clients with Thyroid and Parathyroid Disorders

MULTIPLE CHOICE

1. A nurse is caring for a client with Graves disease. Based on clinical manifestations, which nursing diagnosis would be most appropriate?

a.

Altered Body Image

b.

Constipation

c.

Fluid Volume Deficit

d.

Impaired NutritionMore Than Body Requirements

ANS: A

Clients with Graves disease often have a startling appearance with a swollen neck, evidence of weight loss, and edematous protruding eyes. Clients may need much support to adjust to the physical changes that accompany this disease. They may have diarrhea, not constipation.

DIF: Analysis/Analyzing REF: p. 1024 OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

2. In a client admitted to the clinical unit with a sporadic goiter, the nurse might expect to find that the client

a.

frequently travels in foreign countries.

b.

has a large intake of aspirin.

c.

ingests a large amount of cabbage.

d.

lives in the Great Lakes region.

ANS: C

Sporadic goiter is not restricted to any geographic area. Major causes include ingestion of large amounts of nutritional goitrogens, such as rutabagas, cabbages, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes. Aspirin intake is not related.

DIF: Comprehension/Understanding REF: p. 1019 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. The nurse should assess a client with a history of hypothyroidism for

a.

goiter.

b.

Graves disease.

c.

Hashimotos thyroiditis.

d.

myxedema.

ANS: D

Myxedema is a complication of hypothyroidism characterized by a general hypometabolic state. Myxedema coma is a medical emergency that, if untreated, is nearly always fatal. Goiter is simply an enlarged thyroid gland. Graves disease is the most common form of hyperthyroidism. Hashimotos thyroiditis is a chronic condition.

DIF: Application/Applying REF: p. 1021 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

4. The nurse counseling a client in the prevention of goiter would suggest an increased intake of

a.

calcium.

b.

iodine.

c.

potassium.

d.

protein.

ANS: B

Health promotion practices to prevent goiter include ingestion of iodized salt and avoidance of goitrogens.

DIF: Comprehension/Understanding REF: p. 1020 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

5. In the assessment of a client with hypothyroidism, the nurse would include

a.

serum calcium levels.

b.

serum cholesterol levels.

c.

urine glucose levels.

d.

urine specific gravity.

ANS: B

The most important changes caused by the decreased levels of thyroid hormone are those affecting lipid metabolism. There is a resultant increase in serum cholesterol and triglyceride levels and an increase in arteriosclerosis and coronary artery disease in clients with hypothyroidism.

DIF: Application/Applying REF: p. 1021 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

6. As part of the care plan to meet the needs of a client with mild hypothyroidism, the nurse would

a.

apply an astringent to the clients skin to promote dryness.

b.

plan a strenuous exercise regimen to decrease weight.

c.

set the thermostat between 75 and 80 F to provide a comfortable climate.

d.

suggest the consumption of dense fruit to decrease diarrhea.

ANS: C

The hypothyroidism client is hypothermic because of subnormal metabolism and needs a warmer environment for comfort. The client is also constipated, has little energy, and has dry skin and hair.

DIF: Application/Applying REF: p. 1021 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

7. To increase the comfort of a client with exophthalmos, the nurse would

a.

elevate the head of the bed at night.

b.

provide warm soaks.

c.

restrict activity.

d.

restrict fluids.

ANS: A

General nursing interventions also help to reduce eye discomfort and prevent corneal ulceration and infection in the client with exophthalmos. The nurse should elevate the head of the bed at night and have the client restrict salt intake to relieve edema.

DIF: Application/Applying REF: p. 1025 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

8. In a newly admitted client with thyrotoxicosis, the nurse would plan to address the clinical manifestation of

a.

fluid overload.

b.

hypothermia.

c.

respiratory distress.

d.

tachycardia.

ANS: D

Thyroid storm is a potentially fatal, acute episode of thyroid overactivity characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability.

DIF: Application/Applying REF: p. 1026 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

9. In the initial treatment of a teenager with hyperthyroidism, the nurse would anticipate using

a.

levothyroxine sodium (Synthroid).

b.

liothyronine sodium (Cytomel).

c.

methimazole (Tapazole).

d.

radioactive iodine (131I).

ANS: C

Antithyroid therapy is recommended for hyperthyroid clients under 18 years of age and pregnant women. The major medications used to control hyperthyroidism include thioureas, propylthiouracil, and methimazole.

DIF: Comprehension/Understanding REF: p. 1025 OBJ: Intervention

MSC: Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

10. In a client with Graves disease receiving radioiodine, the nurse would monitor for the common treatment complication of

a.

hypothyroidism.

b.

pulmonary emboli.

c.

skin breakdown.

d.

urinary tract infection.

ANS: A

Because radioiodine destroys thyroid cells, a major complication of 131I therapy is potential hypothyroidism.

DIF: Application/Applying REF: pp. 1025-1026

OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

11. A nurse assessing a client finds a thyroid nodule that is hard, irregular, and painless. The nurse should suspect

a.

exophthalmos.

b.

goiter.

c.

Hashimotos thyroiditis.

d.

thyroid cancer.

ANS: D

Clinical manifestations of thyroid cancers are a rapidly enlarging hard, irregular, painless nodule in an enlarged thyroid gland.

DIF: Comprehension/Understanding REF: p. 1032 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. A client just returned from surgery for a thyroid disorder and complains that his/her mouth has an odd sensation. Which medication should the nurse anticipate administering?

a.

Calcium gluconate

b.

Epinephrine

c.

Potassium chloride

d.

Rectal aspirin

ANS: A

Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations may develop 1 to 7 days after surgery. If the client develops positive Chvosteks or Trousseaus sign, numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching, the nurse should call the physician immediately and anticipate giving calcium gluconate. The nurse should ensure that calcium gluconate ampules are available at the bedside and the client has a patent intravenous line.

DIF: Analysis/Analyzing REF: pp. 1027-1028

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

13. In making emergency equipment available at the bedside of a client who has undergone subtotal thyroidectomy, the nurse would include

a.

a defibrillator.

b.

a tracheostomy set.

c.

an electrocardiogram (ECG) monitor.

d.

an intra-aortic balloon pump.

ANS: B

The nurse should assemble the equipment at the bedside before the client returns from surgery. The equipment includes a blood pressure cuff and stethoscope, additional pillows, oxygen, suction equipment, intubation supplies, and a tracheostomy set.

DIF: Application/Applying REF: p. 1027 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

14. The nurse caring for a client after a thyroidectomy plans care understanding that which of the following nursing diagnoses takes priority?

a.

Acute Pain

b.

Imbalanced Nutrition

c.

Impaired Skin Integrity

d.

Risk for Suffocation

ANS: D

Although uncommon, there is a real risk of respiratory obstruction related to swelling at the surgical site or postoperative bleeding. Although all options are valid diagnoses, the airway diagnosis takes priority, particularly in the immediate postoperative period.

DIF: Comprehension/Understanding REF: p. 1027 OBJ: Diagnosis

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

15. The nursing diagnosis Impaired Urinary Elimination has been assigned to the client with hyperparathyroidism. To address this diagnosis, the nurse would

a.

encourage the client to void frequently.

b.

force fluids to 3 liters/day.

c.

not administer fluids with meals.

d.

withhold acidic juices in the diet.

ANS: B

The client should take in at least 3000 ml of fluid a day. Dehydration is dangerous for clients with hyperparathyroidism because it both increases the serum calcium level and promotes the formation of renal stones.

DIF: Application/Applying REF: p. 1035 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. The nurse caring for a client with hyperparathyroidism should assign priority to

a.

averting infection.

b.

coughing hourly.

c.

encouraging exercise.

d.

preventing falls.

ANS: D

The client with hyperparathyroidism is at great risk for injury, leading to the nursing diagnosis Risk for Injury related to demineralization of bones resulting in pathologic fractures.

DIF: Analysis/Analyzing REF: p. 1033 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

17. In a client with hyperthyroidism, the nurse would expect to see

a.

anorexia, constipation, and cold extremities.

b.

blurred vision, night sweats, and palpitations.

c.

heat intolerance, weight loss, and diarrhea.

d.

muscle cramps, paresthesias, and numbness of the fingers and toes.

ANS: C

Weight loss occurs as a result of quickened metabolism in hyperthyroid clients. Manifestations include loose bowel movements, heat intolerance, profuse diaphoresis, tachycardia, and incoordination caused by tremor. The skin becomes warm, smooth, and moist because of accelerated circulation to the tissues. Hair appears thin and soft.

DIF: Comprehension/Understanding REF: p. 1024 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

18. Self-care measures the nurse should teach a client with hypoparathyroidism include eating a

a.

high-calcium, low-phosphorus diet.

b.

high-phosphorus, high-calcium diet.

c.

low-calcium, low-protein diet.

d.

low-protein, high-calorie diet.

ANS: A

The client with hypoparathyroidism should be on a diet high in calcium but low in phosphorus.

DIF: Comprehension/Understanding REF: pp. 1037, 1038

OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

19. To aid in immobilizing the head of a client after thyroidectomy, the nurse would obtain

a.

a headboard.

b.

hand towels.

c.

Kerlix rolls.

d.

sandbags.

ANS: D

The nurse should support the clients head and neck with pillows and sandbags after thyroidectomy.

DIF: Application/Applying REF: pp. 1030-1031

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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