MSN Exam for Hyperthyroidism

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1) Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with hyperthyroidism?

  1. Increased and rapid heart rate
  2. Decrease systolic blood pressure
  3. Increased respiratory rate
  4. Decreased oral temperature

2) For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?

  1. Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.
  2. Check the apical pulse, blood pressure, and temperature every 4 hours.
  3. Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
  4. Explain the side effects of propylthiouracil (PTU) to the patient.

3) Which nursing diagnosis takes highest priority for a client with hyperthyroidism?

  1. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
  2. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
  3. Body image disturbance related to weight gain and edema
  4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

4) A 38 year old woman returns from a subtotal thryroidectomy for the treatment of hyperthyroidism. Upon assessment, the immediate priority that the nurse would include is:

  1. Assess for pain
  2. Assess for neurological status
  3. Assess fluid volume status
  4. Assess for respiratory distress

5) Which of the following nursing assessment is the most important in the patient with hyperthyroidism and risk for thyrotoxic crisis or thyroid storm?

  1. Intake and output
  2. Heart sounds
  3. Bowel sounds
  4. Vital signs

6) A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?

  1. The client complains of blurred vision.
  2. The client complains of increased thirst and increased urination.
  3. The client complains of increased weight gain over the past year.
  4. The client complains of ringing in the ears.

7) Untreated hyperthyroidism during pregnancy may result in all of the following except:

  1. Premature birth and miscarriage
  2. Low birthweight
  3. Autism
  4. Preeclampsia

8) The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?

  1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test
  2. A decreased TSH level
  3. An increase in the TSH level after 30 minutes during the TSH stimulation test
  4. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay

9) A client is being returned after subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client’s bedside?

  1. Orange juice and hard candy
  2. Tracheostomy set
  3. Cardiac monitor and oxygen tank
  4. Indwelling catheter tray

10) Which medication will the nurse have available for emergency treatment of tetany in the client who has had thyroidectomy?

  1. Calcium chloride
  2. Potassium chloride
  3. Magnesium chloride
  4. Sodium bicarbonate

11) Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to:

  1. Decrease the total basal metabolic rate.
  2. Maintain the function of the parathyroid glands.
  3. Block the formation of thyroxine by the thyroid gland.
  4. Decrease the size and vascularity of the thyroid gland.

12) Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

  1. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
  2. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
  3. Body image disturbance related to weight gain and edema
  4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

13) Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:

  1. decrease the risk of agranulocytosis postoperatively.
  2. prevent tetany while the client is under general anesthesia.
  3. reduce the size and vascularity of the thyroid and prevent hemorrhage.
  4. potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia.

14) What are the functions of T3 and T4?

  1. Retention of salt and water
  2. Maintenance of blood sugar
  3. Maintenance of blood pressure
  4. Regulation of energy production

15) A patient is admitted to the medical unit with possible Graves’ disease (hyperthyroidism). Which assessment finding supports this diagnosis?

  1. Periorbital edema
  2. Bradycardia
  3. Exophthalmos
  4. Hoarse voice
Answers and Rationales
  1. A. Increased and rapid heart rate . The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Focus: Delegation/supervision
  2. B. Check the apical pulse, blood pressure, and temperature every 4 hours. Monitoring and recording vital signs are within the education scope of nursing assistants. An experienced nursing assistant should have been taught how to monitor the apical pulse. However, the nurse should observe the nursing assistant to be sure that she has mastered this skill. Instructing and teaching patients, as well as performing venipuncture for laboratory samples, are more suited to the educational scope of licensed nurses. In some facilities, an experienced nursing assistant may perform venipuncture, but only after special training. Focus: Delegation/supervision
  3. D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess . In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
  4. D. Assess for respiratory distress . Though fluid volume status, neurological status and pain are all important assessment, the immediate priority for postoperative is the airway management. Respiratory distress may result from hemorrhage, edema, laryngeal damage or tetany.
  5. D. Vital signs 
  6. B. The client complains of increased thirst and increased urination. Increased thirst and increased urination are signs of lithium toxicity.
  7. C. Autism . In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
  8. A. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test . In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
  9. B. Tracheostomy set . After subtotal thyroidectomy, swelling of the surgical site ( the tracheal area) may obstruct the airway. Therefore tracheostomy set should be at the bedside in case of respiratory emergency.
  10. B. Potassium chloride 
  11. D. Decrease the size and vascularity of the thyroid gland. Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed.
  12. D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess . In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.
  13. C. reduce the size and vascularity of the thyroid and prevent hemorrhage. Doses of over 30 mg/day may increase the risk of agranulocytosis. Lugol’s solution does not act to prevent tetany. Calcium is used to treat tetany. The client may receive iodine solution (Lugol’s solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Lugol’s solution does not potentiate any other preoperative medication.
  14. D. Regulation of energy production 
  15. C. Exophthalmos . Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism due to Graves’ disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization

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