Online Nursing Practice Test/Exam about Endocrine (31-35)

Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adult-onset Myxedema.

31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:

a) facial puffiness
b) intolerance to heat
c) exopthalmus
d) heart palpitations

32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which finding should the nurse expect?

a) decreased serum T4 and decreased serum cholesterol
b) decreased serum T4 and increased serum cholesterol
c) increased serum T4 and increased serum cholesterol
d) increased serum T4 and increased serum cholesterol

33. Which of the following manifestations does the nurse expect in a client with myxedema?
a) increased heart rate
b) edema
c) weight loss
d) intolerance to heat

34. Which of the following are most important to monitor in a client who had undergone total thyroidectomy?

a) pulse and temperature
b) serum electrolyte levels
c) weight and food intake
d) hoarseness of the voice and ability to swallow

35. Which of the following should be included when giving health teachings to a client with hyperthyroidism.

a) wear long-sleeved clothing
b) use artificial tears to the eyes as necessary
c) increase fibers in the diet
d) take medications with milk



ANSWERS AND RATIONALE

31) A
- Hypothyroidism is due to absence or deficiency in thyroid hormone that causes a decline in the metabolic rate. It is classified according to the time or life in which it occurs:

• Cretinism - hypothyroidism in infants and young children
• Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult
• Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults

Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:

• Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body, including the face which appears puffy and the tongue which is enlarged. The edema is due to accumulation of mucoprotein and water retention.
• Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine. Hypothyroidism caused by lack of TSH does not cause goiter.
• Bradycardia, hypotension, dysrrhythmias, enlarged heart
• Apathy, slow and slurred speech, lethargy
• Decreased heat production-sensitivity to cold
• Decreased nutrient requirements: poor appetite
• Decreased sweat and sebaceous gland function: dry scaly skin
• Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing, decreased blood glucose, hypoalbuminemia
• Decreased erythropoietin production: anemia

32) B
- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.

Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making the patient at risk for atherosclerosis and cardiac disorders.

Management:

1. Prevention - prevention of iodine deficiency

2. Replacement therapy throughout life
a. Drugs used:

• Sodium L-thyroxine/levothyroxine (Synthroid, Levoid)
• Sodium L-triidothyroxine (Cytomel, Trionine)
• Synthetic combination of T3 and T4 (Euthroid, thyrolar)
• Natural combination of T3 and T4 extract

b. Major Side Effects:

• Inadequate treatment - show recurrence/persistence of signs of hypothyroidism
• Excessive treatment - show signs of hyperthyroidism
• Too fast increase in drug dose - angina, palpitations, tachycardia
• Bone loss and decreased bone density

c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and then thyroid therapy is monitored annually.

3. Nursing Care:

• Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest pain, stop activity
• Constipation - increase fiber and fluids
• Hypothermia - maintain comfortable environmental temperature, use blankets as necessary
• Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion
• maintain safe environment
• promote positive body image - educate about reversible body changes

4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation, inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and syncope) caused by pressure on veins that venous return from the head.


33) B
- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)

34) A
- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse and temperature.

35) B
- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.


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Related Topics:

• Online Nursing Practice Test/Exam about Endocrine (36-40)
• Go back to Online Nursing Practice Test about Endocrine Disorder (1-7) to start the test from the beginning.