Chapter 47: Thyroid and Parathyroid Disorders Nursing School Test Banks

Chapter 47: Thyroid and Parathyroid Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A physician ordered T3 and T4 tests for a young woman complaining of fatigue, weight gain, muscle aches and pains, and constipation. Which laboratory test results will help confirm the diagnosis of hypothyroidism?
a. Both tests show decreases.
b. Both tests show increases.
c. The T3 test elevates, and the T4 test decreases.
d. The level of thyroxin rises and then falls back to subnormal levels.
ANS: A
These complaints are strongly suggestive of thyroid disorder; T3 and T4 laboratory diagnostic tests are the most useful.

DIF: Cognitive Level: Knowledge REF: p. 1038 | p. 1047
OBJ: 2 TOP: Thyroid Diagnostic Tests
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

2. Which instruction should a nurse provide when a patient starts taking a saturated solution of potassium iodide (SSKI)?
a. Sip medication through a straw to prevent tooth staining.
b. Double the dose if a dose is missed.
c. Expect excessive salivation.
d. Take before meals.
ANS: A
SSKI can discolor teeth if not sipped through a straw; no iodide drug should be doubled; excessive salivation is a sign of toxicity; and the medication should be taken after meals.

DIF: Cognitive Level: Comprehension REF: p. 1040 OBJ: 1
TOP: SSKI KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. A patient with a hyperthyroid complains of fatigue but still cannot get to sleep. What is the best suggestion by the nurse?
a. Taking cat naps during the day
b. Adhering to a bedtime ritual
c. Drinking a cup of cocoa before bedtime
d. Performing mild prebedtime exercises
ANS: B
Bedtime rituals such as a warm bath, reading, and listening to music cue the body for sleep. Naps during the day may make nighttime sleep difficult; exercising and drinking caffeine-filled drinks are stimulating and should be avoided by the person with insomnia.

DIF: Cognitive Level: Comprehension REF: p. 1042 OBJ: 3
TOP: Hyperthyroidism Insomnia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. Which significant need should be included in instructions to a patient scheduled for a thyroid scan (123I)?
a. Provision of a special container to collect urine for the next 24 hours
b. Wear a protective apron to shield him or her from radiation for the next 24 hours
c. Request that visitors keep a distance of at least 6 feet away for the next 24 hours
d. Wash their hands with soap and water after every voiding for the next 24 hours
ANS: D
The patient needs to be instructed to use soap and water to wash his or her hands after each voiding for the next 24 hours. If caregivers discard the urine, gloves should be worn and then washed and removed. Caregivers should wash their hands after glove removal.

DIF: Cognitive Level: Application REF: p. 1039 OBJ: 2
TOP: Thyroid Diagnostic Tests KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

5. A patient asks about his laboratory test, which showed a high level of thyroid-stimulating hormone (TSH) and a low level of T4. What is the most accurate explanation?
a. It means that you have an inconsistency in your thyroid tests, and you will need more testing.
b. I am sorry. You will have to ask your physician about your laboratory results. We are not allowed to discuss them.
c. The TSH is sending a message to your thyroid gland to increase production, but your thyroid isnt producing enough hormone.
d. That means that you will have to go on hormone therapy for the rest of your life.
ANS: C
The test determines whether the problem is in the pituitary gland or in the thyroid gland. In this patient, the high level of TSH is coming from the pituitary gland as it should, but the thyroid gland is not responding with adequate hormone production.

DIF: Cognitive Level: Comprehension REF: p. 1036 OBJ: 2
TOP: Thyroid Laboratory Tests KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. A patient with exophthalmos is distressed about her appearance and asks when it will go away. What is the best response by the nurse?
a. It is not reversible.
b. It can be disguised with sunglasses and makeup.
c. It usually subsides after medication for hyperthyroidism is started.
d. It can be minimized with plastic surgery to the eyelids.
ANS: C
The startled appearance of the patient with exophthalmos usually subsides several weeks after therapy for hyperthyroidism becomes effective.

DIF: Cognitive Level: Comprehension REF: p. 1043 OBJ: 2
TOP: Exophthalmia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

7. A nurse is explaining Graves disease to a newly diagnosed patient. Which statement by the nurse best clarifies the pathophysiologic changes of Graves disease?
a. Your thyroid gland is not producing enough hormones; consequently, you will need replacement therapy.
b. Your thyroid gland is overactive, but there are ways to treat it through medicine or surgery.
c. Its an autoimmune disorder that has no satisfactory treatment.
d. Graves disease is a temporary disorder that will gradually subside.
ANS: B
The patient needs to recognize the nurses role in giving accurate, timely information.

DIF: Cognitive Level: Comprehension REF: p. 1038 OBJ: 3
TOP: Graves Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

8. A nurse assessing a patient 1 day after a subtotal thyroidectomy notes that the patients color is poor, the pulse and respirations are rapid, and the patient feels warm to the touch. The patient says that she feels frightened. What is the best initial implementation by the nurse?
a. Tell her that there is nothing to be afraid of and stay to calm her.
b. Ask her if she would like pain medication.
c. Call the charge nurse; these are signs of a thyroid storm.
d. Get a tracheostomy set at the bedside.
ANS: C
Call the charge nurse; these signs and symptoms suggest excessive stimulation caused by an elevated level of thyroid hormones, and the patient needs immediate care.

DIF: Cognitive Level: Application REF: p. 1038 OBJ: 3
TOP: Thyroid Storm KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A patient has been given an antithyroid drug called propylthiouracil. What appropriate nursing implementations should be included?
a. Using special radioactive precautions for her urine for the first 24 hours
b. Monitoring her vital signs and withholding the medications if her pulse is greater than 100 beats/min
c. Teaching her to watch for and report any signs and symptoms of hypothyroidism or infections
d. Keeping her on a low-calorie, low-protein diet
ANS: C
The drug targets the thyroid gland to slow its function. Thionamides may cause suppression of neutrophils leading to a lowered resistance.

DIF: Cognitive Level: Application REF: p. 1041 OBJ: 3
TOP: Antithyroid Medications KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. What is the most appropriate nursing diagnosis for the patient recently diagnosed with hyperthyroidism?
a. Hypothermia, related to increased metabolic processes
b. Constipation, related to increased hormonal stimulation
c. Disturbed body image, related to weight gain
d. Disturbed sleep pattern, related to metabolic disturbance
ANS: D
The patient with hyperthyroidism has trouble staying asleep because of the metabolic disorder. Persons with hyperthyroidism feel uncomfortably warm, which also contributes to their sleeping difficulty.

DIF: Cognitive Level: Application REF: p. 1042 OBJ: 4
TOP: Hyperthyroidism KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. A patient, newly diagnosed with hypothyroidism, is anxious to begin her drug regimen. What should the nurses instructions relative to hormone replacement include?
a. Be certain that no dose is skipped.
b. Be sure and take these drugs just before bedtime.
c. Know the signs and symptoms of hyperthyroidism.
d. You will be able to notice the benefits of thyroid replacement therapy right away.
ANS: C
Overdosing on the thyroid replacement medication will lead to signs and symptoms of hyperthyroidism. The medication is best taken every morning so as not to unduly interrupt sleep patterns.

DIF: Cognitive Level: Application REF: p. 1045 OBJ: 3
TOP: Thyroid Replacement Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. What patient recommendation should a nurse include when preparing to present presurgical teaching of a patient scheduled for a subtotal thyroidectomy?
a. Lie flat on her back for 24 hours to prevent undue strain on the suture line.
b. Be able to verbalize the signs and symptoms of thyroid crisis.
c. Demonstrate how to deep breathe and support her head during position changes.
d. Have a tube in her trachea to assist in breathing.
ANS: C
Teaching the patient to hold and support the head after a thyroidectomy will ease the postoperative period. Consistently supporting the head will prevent stress on the suture line.

DIF: Cognitive Level: Application REF: p. 1043 OBJ: 4
TOP: Thyroidectomy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

13. On returning from surgery after undergoing a thyroidectomy, a patient is alarmed about the large tracheostomy tray on the bedside table. What is the nurses most reassuring response when the patient asks why it is there?
a. We have it there as a precautionary measure in the unlikely event that you have difficulty breathing.
b. If you start bleeding, well be able to take care of it right here at the bedside.
c. We have to keep it there in case of an emergency and the physician needs it.
d. Its hospital policy to have it available for persons who are likely to have respiratory arrest.
ANS: A
The honest answers without any embellishments are best. Suggesting that any emergency is imminent will alarm the patient further. The presence of the tray is an item that should be covered in preoperative teaching.

DIF: Cognitive Level: Comprehension REF: p. 1044 OBJ: 3
TOP: Postoperative Care: Thyroidectomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. What is the appropriate action of the nurse when assessing for hemorrhage in a postthyroidectomy patient?
a. Assess upper chest for the patient positioned in high Fowler position.
b. Turn the patient to the side to check; the patient must be kept flat in the bed.
c. Lift up the neck dressing to assess for excessive bleeding.
d. Examine behind patients neck and upper back to assess for hemorrhage.
ANS: D
Because the dressing is on the front of the neck, blood might flow under the dressing to the back of the neck, since it flows to the most-dependent position. Patients are positioned in a high Fowler position after a thyroidectomy to diminish swelling.

DIF: Cognitive Level: Application REF: p. 1045 OBJ: 3
TOP: Postthyroidectomy Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

15. How do foods such as soybeans, turnips, and rutabagas affect people with thyroid disorders?
a. Suppress thyroid hormone.
b. Decrease the hypothermia of the person with hypothyroidism.
c. Supplement the diet of a person with hypothyroidism.
d. Counteract the effect of iodide therapy.
ANS: A
Turnips, rutabagas, and soybeans are goitrogen substances and suppress the thyroid hormone. Such foods would synergize iodides and increase the symptoms of the patient with hypothyroidism.

DIF: Cognitive Level: Comprehension REF: p. 1046 OBJ: 3
TOP: Goitrogen Substances KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she has taken for 15 years, has been reduced. What is nurses best rationale when explaining what the decreased dose is related to?
a. Improved efficacy of the thyroid preparation
b. Age-related reduction in metabolic rate
c. Drug-related hypertrophy of the thyroid
d. Changes in your diet and activity level
ANS: B
Older patients have slower drug metabolism; consequently, the drug stays in their systems. All patients receiving hormone replacement need to be periodically evaluated.

DIF: Cognitive Level: Comprehension REF: p. 1036 OBJ: 3
TOP: Age-Related Changes in Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

17. A nurse taking the blood pressure of a patient who had a total thyroidectomy 2 days earlier notes that the patients hand goes into a carpopedal spasm. What should the nurse recognize this movement as an indication of?
a. Hyperkalemia, called the Allen sign
b. Hypernatremia, called the Hogan sign
c. Hypocalcemia, called the Trousseau sign
d. Hypokalemia, called the Chvostek sign
ANS: C
The carpopedal spasm is the Trousseau sign, which indicates hypercalcemia. Chvostek sign also signals hypocalcemia.

DIF: Cognitive Level: Application REF: p. 1051 OBJ: 4
TOP: Hypothyroidism KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. What action should a nurse implement to address the nursing diagnosis, Risk for impaired skin integrity, related to dry skin in the patient with hypothyroidism?
a. Increase the frequency of bathing to get rid of dry skin.
b. Apply lotions and creams to help maintain moisture.
c. Increase activities to stimulate circulation in the skin.
d. Take antihistamines to prevent itching.
ANS: B
The skin requires moisturizing lotion to decrease the risk breakdown. Frequent bathing and antihistamines will dry the skin. Exercise does little for skin perfusion.

DIF: Cognitive Level: Application REF: p. 1048 OBJ: 3
TOP: Hypothyroidism KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. What action should a nurse implement to initiate the Chvostek sign?
a. Ask the patient to grimace and note if the facial response is symmetrical.
b. Inflate a blood pressure cuff to the systolic level and watch for a carpopedal spasm.
c. Tap the face over the facial nerve and watch for a spasm of the facial muscle.
d. Check the pupillary response to light and determine whether the pupil accommodates and reacts.
ANS: C
Spasm of the facial muscles is an indicator of low serum calcium levels.

DIF: Cognitive Level: Application REF: p. 1051 OBJ: 3
TOP: Hypocalcemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. What symptoms should a nurse anticipate in the history of a patient with hyperparathyroidism?
a. Fatigue, hyperactive reflexes, muscle cramps, and twitching
b. Poor muscle tone, bone pain, urinary calculi, and fractures
c. Hunger, thirst, and urinary retention
d. Tachycardia, air hunger, and nervousness
ANS: B
The calcium has been leeched from the bones, leading to hypercalcemia and leaving the patient with multiple problems such as a risk for fractures, urinary calculi, and bone pain.

DIF: Cognitive Level: Comprehension REF: p. 1051-1052
OBJ: 3 TOP: Hyperparathyroidism
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. A patient being treated for hyperparathyroidism is to receive calcitonin (Calcimar). Which patient assessment should occur before this medication is administered?
a. Assessment for hydration status
b. Evaluation for cardiac dysrhythmia
c. Test for sensitivity
d. Radiography for the presence of urinary calculi
ANS: C
Because anaphylaxis is not an uncommon side effect of calcitonin, sensitivity testing should be performed before administering the drug.

DIF: Cognitive Level: Application REF: p. 1052-1053
OBJ: 3 TOP: Antihyperparathyroidism Drug
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

22. What is an appropriate nursing diagnosis for a patient with hyperparathyroidism?
a. Impaired urinary elimination, related to urinary calculi
b. Decreased cardiac output, related to heart failure secondary to hypocalcemia
c. Risk for injury, related to hypocalcemia leading to muscle spasms and convulsions
d. Imbalanced nutrition: Greater than body requirements, related to increased appetite
ANS: A
Excessive calcium in the bloodstream leads to the formation of calcium stones in the urinary system.

DIF: Cognitive Level: Application REF: p. 1052 | p. 1054
OBJ: 4 TOP: Hyperparathyroidism: Nursing Diagnosis
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

23. What is the nurse aware is happening when the patient with hypoparathyroidism complains of fatigue and a lack of energy?
a. Hypertension is the cause of the fatigue.
b. Hypocalcemia has caused decreased cardiac output.
c. Dyspnea has sapped the patients energy.
d. Poor muscle tone makes any activity tiring.
ANS: B
A decreased amount of calcium in the bloodstream decreases the contractility of the heart and, consequently, reduces cardiac output.

DIF: Cognitive Level: Comprehension REF: p. 1055 OBJ: 4
TOP: Hypoparathyroidism KEY: Nursing Process Step: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. Why should a nurse recommend the use of salt that is iodized when providing dietary education to patients?
a. It prevents the development of goiter in adults and cretinism in infants.
b. It can help prevent hypothyroidism.
c. It is instrumental in preventing tumors of the parathyroid gland.
d. It works as an important component of thyroid replacement therapy.
ANS: A
Iodine is needed to convert thyroid hormones. Without it, the TSH continues to send the message to the thyroid gland to increase production of thyroid hormones.

DIF: Cognitive Level: Knowledge REF: p. 1042 OBJ: 3
TOP: Nutrition Concepts KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

25. Which intervention is necessary to assist a patient with hypothyroidism to understand how he can live a full and normal life?
a. Teach the importance of taking antithyroid medication until it is no longer needed.
b. Encourage exercise to burn extra calories and maintain a normal weight.
c. Teach him to take care of energy needs through adequate nutrition.
d. Encourage treatment with thyroid replacement therapy.
ANS: D
Hormones can adequately and effectively replace the missing thyroid hormone.

DIF: Cognitive Level: Application REF: p. 1047 OBJ: 3
TOP: Hypothyroidism: Pharmacology KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

26. Why are antithyroid medications provided presurgically to a patient with hyperthyroidism? (Select all that apply.)
a. To decrease the level of hormone in the blood before surgery
b. To help reduce the risk of hemorrhage during surgery
c. To decrease the threat of a thyroid storm
d. To reduce exophthalmia
e. To increase weight
ANS: A, B, C, D
The antithyroid medication will do all of the above except for increasing weight in a patient with hyperthyroidism.

DIF: Cognitive Level: Comprehension REF: p. 1039-1040
OBJ: 3 TOP: Presurgical Use of Antithyroid Drugs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

27. What should a nurse caring for a patient with hyperthyroidism include when developing a plan of care? (Select all that apply.)
a. Decreasing weight
b. Provision of a cool environment
c. Eye care
d. Nutritional support
e. Prevention of diarrhea
ANS: B, C, D, E
A patient with hyperthyroidism does not need to lose weight, but he or she needs to gain it. All other options are appropriate concerns for such a patient.

DIF: Cognitive Level: Application REF: p. 1043-1044
OBJ: 4 TOP: Care Plan for Patient Hyperthyroidism
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

28. A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a thionamide drug, should report. What should this list include? (Select all that apply.)
a. Becoming pregnant
b. Jaundice
c. Blood in the stool
d. Rash
e. Urine retention
ANS: A, B, C, D
Urine retention is not a side effect of methimazole (Tapazole).

DIF: Cognitive Level: Knowledge REF: p. 1041 OBJ: 4
TOP: Patient Education for Thionamides KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

29. Why is hypothyroidism frequently overlooked in older adults? (Select all that apply.)
a. Signs and symptoms are subtle.
b. Signs and symptoms are discounted as age-related changes.
c. Weight changes in the older adult are not pronounced.
d. Older adults are not susceptible to thyroid disorders.
e. Decrease in mental function is attributed to dementia.
ANS: A, B, C, E
Older persons, especially women, are quite prone to hypothyroidism. Other major symptoms are overlooked or discounted as related to advancing age. Many of the symptoms of hypothyroidism are subtle and discounted as age-related changes or dementia. Weight changes are not pronounced as they are in younger people.

DIF: Cognitive Level: Comprehension REF: p. 1036 OBJ: 3
TOP: Hypothyroidism KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

30. To meet the nutritional needs of a patient with Graves disease, the nurse recommends a diet of _____ to _____ calories.

ANS:
4000; 5000
The patient with Graves disease has a high metabolism, which requires a large caloric intake. These patients need 4000 to 5000 calories a day.

DIF: Cognitive Level: Knowledge REF: p. 1042 OBJ: 4
TOP: Nutritional Needs of the Patient with Graves Disease
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

31. Congenital hypothyroidism, if left untreated, will result in _____.

ANS:
cretinism
Cretinism is the result of untreated congenital hypothyroidism.

DIF: Cognitive Level: Knowledge REF: p. 1045 OBJ: 3
TOP: Cretinism KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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