1. A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal thyroid-stimulating hormone (TSH) levels. Which is the nurse’s priority intervention?

a.            Administer levothyroxine (Synthroid).

b.            Administer propranolol (Inderal).

c.             Monitor the apical pulse.

d.            Assess for Trousseau’s sign.

ANS: C

The client’s laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client’s heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Synthroid is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau’s sign is a test for hypocalcemia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

2. Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?

a.            “You will have external beam radiation.”

b.            “No radiation is used for this scan.”

c.             “No special radiation precautions are needed.”

d.            “Your thyroid will be radioactive for weeks.”

ANS: C

The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life that the client is not considered to be a radiation hazard. Thus, no radiation precautions are necessary. The other statements are inaccurate.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1396

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Diagnostic Tests) MSC: Integrated Process: Teaching/Learning

3. Which dietary modification does the nurse provide for a client with hyperthyroidism?

a.            Decreased calories and proteins and increased carbohydrates

b.            Elimination of carbohydrates and increased proteins and fats

c.             Increased calories, proteins, and carbohydrates

d.            Supplemental vitamins and reduction of calories

ANS: C

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

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Nursing Process (Implementation)

4. A client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the client is having side effects of this therapy?

a.            Blurred vision

b.            Increased thirst and urination

c.             Increased sweating and diarrhea

d.            Decreased attention span and insomnia

ANS: B

Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. The other choices are not specific to lithium.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Evaluation)

5. A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. Which is the nurse’s best response?

a.            “Iodine will help make the internal surgical environment sterile.”

b.            “It is given to stimulate the storage of excess thyroid hormones.”

c.             “This will replace the hormones you will lose after your operation.”

d.            “It will prevent excessive bleeding during surgery.”

ANS: D

Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery. The other answers are not accurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

6. Twelve hours after a total thyroidectomy, the client develops stridor. Which is the nurse’s priority intervention?

a.            Reassure the client that the voice change is temporary.

b.            Document the finding and assess the client hourly.

c.             Hyperextend the client’s neck and apply oxygen.

d.            Prepare for emergency tracheostomy and call the health care provider.

ANS: D

Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. The other choices do not address the emergency situation.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Medical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

7. On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around his mouth. Which is the nurse’s priority intervention?

a.            Offer mouth care.

b.            Loosen the dressing.

c.             Assess Chvostek’s sign.

d.            Assess the client hourly.

ANS: C

Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek’s sign and Trousseau’s sign. Then the nurse should notify the provider. The other choices do not address the emergency situation.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Analysis)