HESI Case Study Thyroid Disorders Questions and Answers

HESI Case Study Thyroid Disorders Questions and Answers The client's presenting vital signs: Temperature: 96.0° F (36.0° C)Pulse: 52 beats/minute Respirations: 18 breaths/minute Blood pressure: 140/80 mmHg Given the initial history and vital signs, what other questions should the nurse ask? (Select all that apply. One, some, or all options may be correct.) "Have you had any changes in your bowel habits?" "Have you noticed an increase in urinary frequency?" "Do you still feel sleepy when you wake up in the mornings despite getting a good night's sleep?" "Have you noticed any changes in your hair or nails?" "Do you think your weight gain is because you eat too much?" "Have you had any changes in your bowel habits?" "Do you still feel sleepy when you wake up in the mornings despite getting a good night's sleep?" "Have you noticed any changes in your hair or nails?" The client has signed the consent for the radioactive iodine uptake test. What are the most important assessments for the nurse to obtain prior to the test? (Select all that apply. One, some, or all options may be correct.) Ask if the client has been taking any OTC medications such as cough syrups? Determine if the client has eaten in the past 4 hours. Investigate the client's use of over the counter (OTC) multivitamin and herbal products. Find out if the client has ever had a reaction to a bee sting. Assess the client's history for allergic reaction to peanuts. Ask if the client has been taking any OTC medications such as cough syrups? Investigate the client's use of over the counter (OTC) multivitamin and herbal products. Find out if the client has ever had a reaction to a bee sting. Rationale: -Anything that contains iodine -Allergic reactions to bee stings and shell fish should be assessed. Based on the client's history and presenting symptoms, which additional diagnostic tests does the nurse anticipate the HCP to order?(Select all that apply. One, some, or all options may be correct.) CBC with differential. Blood Chemistries. TSH and free T4. Chest X-ray (CXR). Arterial blood gases (ABG's). CBC with differential. (The HCP needs to rule out other possible causes of the client's symptoms which could include anemia or an infection.) Blood Chemistries. (Chemistries would be needed to evaluate the client's electrolyte and fluid status.) TSH and free T4. (These indicate the functioning or non-functioning of the thyroid gland) Based on the health care provider's (HCP) assessment and interpretation of the diagnostics, the client is diagnosed with hypothyroidism. Which other lab should be monitored after the diagnosis of hypothyroidism is confirmed? Triglycerides and cholesterol. (Hypothyroidism can cause increased triglyceride and cholesterol levels, leading to coronary atherosclerosis.) The client asks the nurse how she got this disease. Which explanation by the nurse is accurate? An autoimmune dysfunction causes thyroid dysfunction. (The most common cause of hypothyroidism in adults is autoimmune thyroiditis (Hashimoto's disease) in which the immune system attacks the thyroid. More than 95% of clients either have primary or thyroidal hypothyroidism which refers to dysfunction of the thyroid itself.) Which symptoms are the client with hypothyroidism most likely to exhibit? (Select all that apply. One, some, or all options may be correct.) Tachycardia and palpitations. Somnolence and fatigue. Coarse dry skin. Somnolence and cold intolerance. Diarrhea and weight loss. Somnolence and fatigue. (Hypothyroidism generally causes an individual to have decreased initiative, somnolence, slowed speech, fatigue and lethargy.) Coarse dry skin. (This is a manifestation of hypothyroidism.) Somnolence and cold intolerance. What is the client's daily dose of medication? (Enter numerical value only. If rounding is necessary, round to the hundredth.) 0.115 150 lbs = 68.18 kg 68.18 x 1.7 mcg = 115.9 mcg 115.9 mcg /1000 = 0.115 mg Which approach by the nurse describes the action of the levothyroxine? Increases fat, protein, carbohydrate metabolism. (The action of levothyroxine is the same as endogenous thyroid hormone. The drug increases the metabolic rate (increased oxygen consumption, respiration and heart rate) and increases the rate of fat, protein, and carbohydrate metabolism. It promotes growth and maturation.) Which information in the client's history would be of concern to the nurse related to the use of levothyroxine? The client has an allergy to Non-steroidal anti-inflammatories (NSAIDS) medications. The client eats her last meal of the day around 7:00 p.m. The client takes a daily calcium supplement. The client prefers to take her medications with a full glass of water. Submit The client takes a daily calcium supplement. (Calcium should be taken at least four hours after the Levothyroxine dose to prevent interference with absorption.) The client tells the nurse she has a hard time taking medications regularly. She asks how long she will need to take the Levothyroxine. What is the nurse's best response? You will need to take this medication for the remainder of your life. Which instructions should the nurse include when teaching the client about levothyroxine sodium? (Select all that apply. One, some, or all options may be correct.) This medication should be is taken twice a day with food. This medication requires periodic lab work to monitor levels. When refilling this medication, ask the pharmacist for the least expensive brand of the medication. Report chest pain, a rapid heartbeat, or increased nervousness to the HCP. Wear a medical alert bracelet. This medication requires periodic lab work to monitor levels. Report chest pain, a rapid heartbeat, or increased nervousness to the HCP. Wear a medical alert bracelet. Prior to the administration of each dose of levothyroxine, it is important to obtain which assessments? (Select all that apply. One, some, or all options may be correct.) Administer the medication prior to eating breakfast. Record blood glucose. Ensure that the heart rate is less than 100. Record intake for the past 12 hours. Assess the client's bowel sounds. Administer the medication prior to eating breakfast. Ensure that the heart rate is less than 100. Which behavior indicates to the nurse that the client understands the instructions related to the new medication? Eugena states that she will need to notify the HCP of any chest pain. (Chest pain can indicate a problem with the cardiovascular system. Clients should be instructed to monitor their pulse and to report tachycardia, an irregular pulse, or palpitations to the HCP.) The client reports to the nurse that she took an antidepressant for several months and because of how she's feeling, she'd like to restart her medication. Which is the most important advice by the nurse? Advise her to check with the HCP first. (Sedatives can increase the sensitivity to hormone replacement therapy. These medications should only be used if approved by the HCP.) Based on the diagnosis of hypothyroidism, what condition does the nurses suspect the client is experiencing? Myxedema crisis. (Myxedema is a rare life threatening condition that is a decompensated state of severe hypothyroidism.) Upon admission, the nurse should give the highest priority to meeting which need of a client who is brought to the ED with Myxedema crisis? (Select all that apply. One, some, or all options may be correct.) Assess cardiac system. Insert a Foley catheter Ask about current immunizations and medications. Start an IV of Normal Saline at prescribed rate. Cover the client with warm blankets. Assess cardiac system. (Myxedema crisis is life threatening. It is imperative to monitor for circulatory collapse.) Start an IV of Normal Saline at prescribed rate. (This action is priority to prevent circulatory collapse.) Cover the client with warm blankets. (Hypothermia is a common symptom with myxedema crisis.) Other therapies for myxedema crisis include maintaining a patent airway, administration of IV levothyroxine sodium, IV glucose, and IV corticosteroids. Nurses should continue to monitor the vital signs, especially the blood pressure, heart rate and temperature hourly until stable. Eugena's blood gases are as follows: pH: 7.33 pCO2: 50 PaO2: 99 HCO3: 24 Based on the nurse's assessment of these labs which finding accurately describes the results? Respiratory acidosis. What information should the nurse provide as a potential cause of a myxedema crisis? Contracting the flu. (Viral infections can be a trigger for a myxedema crisis. Other triggers include the use of drugs (such as opioids, tranquilizers and barbiturates), exposure to cold, and trauma.) Which is the best response by the nurse? "It sounds like that was a very frightening experience for you." (The best response is to acknowledge and support Eugena's fears and concerns. This is an open-ended statement that will encourage Eugena to continue to express her fears.) The client also panics and admits to the nurse that she can't remember if she took her pill this morning. It is about 2 pm in the afternoon. Which information is important for the nurse to provide to the client? Advise the client that she will notify the HCP to call her with further instruction. At her six week appointment, The client reports of fatigue, some increasing constipation, and weight gain. Her serum TSH level is still elevated. Based on the clinical manifestations and lab results, what change in medication should the nurse anticipate? Increase her dose of levothyroxine. (The client is still exhibiting symptoms of hypothyroidism, which will require an increase in her dose of levothyroxine. Her dose will be increased as needed.) Which diagnosis would be included in the plan of care? Decreased cardiac output. (Decreased heart rate and force of contraction can lead to symptoms of diminished cardiac output.) Which is the best response for the nurse when instructing the client about the use of supplemental iodine? The use of salt with iodine and a well-balanced diet should provide adequate iodine. At the two week visit, the client and the nurse have more discussions about her dietary intake. The nurse knows that the client understands her dietary needs when she makes which statement? "Foods that I should include in my diet include tuna, yogurt, and macaroni." (all these foods are good sources of iodine) On the fourth week visit, the nurse recognizes that the client is improving when she assesses which of the following? (Select all that apply. One, some, or all options may be correct.) The client has lost 5 pounds. The client reports that she has begun walking around the track twice a week. The client's heart rate over the past weeks has range 46 to 52 beats/min. The client's temperature over the past weeks has range 94° to 95° F orally. The client reports that her bowel habits have returned to normal. The client has lost 5 pounds. (Weight gain is a symptom of hypothyroidism. Weight loss is a sign of improvement of thyroid function.) The client reports that she has begun walking around the track twice a week. (Increased energy level is sign of improved thyroid function. Hypothyroidism causes decreased energy levels.) The client reports that her bowel habits have returned to normal. (Hypothyroidism causes constipation. As the thyroid improves, bowel habits should return to the client's baseline.)